Complex Polypharmacy in Bipolar Disorder: Side effect burden, adherence, and response predictors
| Autor: | Noreen A. Reilly-Harrington, Joseph R. Calabrese, Louisa G. Sylvia, Richard C. Shelton, Vicki Fung, William V. Bobo, Thilo Deckersbach, Michael E. Thase, Masoud Kamali, Andrew A. Nierenberg, Keming Gao, Lindsay Overhage, Mauricio Tohen, Terence A. Ketter |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Generalized anxiety disorder Bipolar Disorder Side effect Drug-Related Side Effects and Adverse Reactions Medication adherence Comorbidity Logistic regression Article Medication Adherence 03 medical and health sciences 0302 clinical medicine Rating scale Internal medicine medicine Humans Bipolar disorder Unmeasured confounding Randomized Controlled Trials as Topic Polypharmacy business.industry Middle Aged medicine.disease Anxiety Disorders 030227 psychiatry Psychiatry and Mental health Clinical Psychology Logistic Models Treatment Outcome Female Self Report business 030217 neurology & neurosurgery |
| Zdroj: | J Affect Disord |
| Popis: | Background Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP. Methods We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks). Results 43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP. Limitations There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error. Conclusions BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens. |
| Databáze: | OpenAIRE |
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