Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response
| Autor: | Bruce J. Kinon, Haya Ascher-Svanum, David H. Adams, Sara E. Edwards, Lei Chen, Hong Liu-Seifert, Pandurang M. Kulkarni, Virginia L. Stauffer, Leslie Citrome, Jean-Pierre Lindenmayer, Peter F. Buckley, Jan Volavka |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Patient Dropouts Schizoaffective disorder Severity of Illness Index law.invention Medication Adherence Benzodiazepines Randomized controlled trial law Recurrence Internal medicine Post-hoc analysis Severity of illness medicine Humans Psychiatry Psychiatric Status Rating Scales Positive and Negative Syndrome Scale business.industry Weight change Odds ratio medicine.disease Discontinuation Diagnostic and Statistical Manual of Mental Disorders Psychiatry and Mental health Treatment Outcome Psychotic Disorders Olanzapine Schizophrenia Female business Antipsychotic Agents |
| Zdroj: | The Journal of clinical psychiatry. 70(7) |
| ISSN: | 1555-2101 |
| Popis: | OBJECTIVE To examine the impact of medication nonadherence on treatment outcome in schizophrenia and potential risk factors for nonadherence. METHOD A post hoc analysis of a randomized, double-blind, 8-week, fixed-dose study comparing olanzapine 10, 20, and 40 mg/day for patients with schizophrenia or schizoaffective disorder (DSM-IV criteria) with suboptimal response to current treatment (N = 599) was conducted between September 12, 2003, and November 3, 2005, at 55 study centers in the United States. Nonadherence was defined as not taking medication as prescribed based on daily pill counts. Because there was no significant difference in nonadherence between dose groups, effects of nonadherence on efficacy and safety outcomes were examined using all 3 groups combined. Baseline demographics and symptom severity were investigated as potential risk factors for nonadherence. RESULTS During the 8-week study, 34.5% of patients were nonadherent at least once. Nonadherent patients had significantly less improvement compared to adherent patients as measured by change in Positive and Negative Syndrome Scale total score (-22.57 vs. -26.84, p = .002). Longer duration of nonadherence was associated with reduced likelihood of treatment response (odds ratio = 0.94, 95% CI = 0.90 to 0.99, p = .008). The early treatment discontinuation rate was higher in nonadherent compared to adherent patients (40.8% vs. 24.5%, p < .001). Adherent and nonadherent patients had comparable outcomes in most safety measures, except for weight change, for which adherent patients had greater weight gain than nonadherent patients (2.63 kg vs. 1.96 kg, p = .02). Greater depression severity at baseline (p = .01) and greater hostility level during the study were significant risk factors for nonadherence (p = .02). CONCLUSIONS Medication nonadherence had a significantly negative impact on treatment response, highlighting the importance of adherence to achieve satisfactory treatment outcome. Findings may also help clinicians identify patients at risk for nonadherence and utilize interventions to improve adherence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00100776. |
| Databáze: | OpenAIRE |
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