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Higher persistence with valsartan compared with enalapril in daily practice.

Siiskonen SJ, Breekveldt-Postma NS, Vincze G, Khan ZM, Erkens JA, Herings RM - Vasc Health Risk Manag (2007)

Bottom Line: About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months.Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR(adj): 1.23, 95% CI: 1.16-1.32; 2 years RR(adj): 1.16, 95% CI: 1.11-1.23).Real-life persistence is higher with valsartan than with enalapril.

View Article: PubMed Central - PubMed

Affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht,The Netherlands.

ABSTRACT

Objective: To compare persistence with valsartan and enalapril in daily practice.

Methods: The PHARMO Record Linkage System includes various data registries including drug dispensing and hospitalizations for > or =2 million subjects in the Netherlands. Patients newly treated with valsartan or enalapril in the period of 1999-2002 were selected. Persistence was calculated by summing up the number of days of continuous treatment. Patients who remained on therapy with valsartan or enalapril for 12 or 24 months were defined as persistent at 1 or 2 years, respectively.

Results: 3364 patients received valsartan and 9103 patients received enalapril. About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months. Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR(adj): 1.23, 95% CI: 1.16-1.32; 2 years RR(adj): 1.16, 95% CI: 1.11-1.23).

Conclusions: Real-life persistence is higher with valsartan than with enalapril. The results of this and other studies on persistence in daily practice should be taken into account when deciding upon drug treatment for hypertension.

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Related in: MedlinePlus

Medication persistence with valsartan and enalapril treatment in the first 2 years after the index date (adjusted curves based on the Cox proportional hazard analysis). Percentage of patients still using index drug at (a) 1 year after the index date: 61.6% for valsartan and 55.0% for enalapril and (b) 2 years after the index date: 47.8% for valsartan and 43.0% for enalapril (p < 0.05).
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fig1: Medication persistence with valsartan and enalapril treatment in the first 2 years after the index date (adjusted curves based on the Cox proportional hazard analysis). Percentage of patients still using index drug at (a) 1 year after the index date: 61.6% for valsartan and 55.0% for enalapril and (b) 2 years after the index date: 47.8% for valsartan and 43.0% for enalapril (p < 0.05).

Mentions: 61.6% of patients starting valsartan and 55.0% of patients starting enalapril remained on therapy with the index drug at one year after the initial dispensing. Sensitivity analyses for 1-year persistence showed that about 50% of patients starting valsartan and 45% of patients starting enalapril remained on therapy when a 30-day gap was used and about 65% of patients starting valsartan and 60% of patients starting enalapril remained on therapy when a 90 day gap was used. At two years after start, 47.8% of patients starting valsartan and 43.0% of patients starting enalapril were still using the index drug. Patients starting valsartan were 20% (1.2 times) more likely to persist with the initial therapy than patients starting enalapril at 1 and 2 years, after adjustment for differences in patient characteristics (RR1year: 1.23, 95% CI: 1.16–1.32; RR2 years: 1.16, 95% CI: 1.11–1.23) (Table 2 and Figure 1). Factors adjusted for and associated with increased persistence in the multivariate analyses were higher age, male gender, specialist as prescriber, concomitant use of other antihypertensive drugs, and previous use of concurrent cardiovascular medication as well as previous cardiovascular hospitalizations (data not shown). The lower persistence with enalapril was mainly due to higher rate of discontinuation of the drug during the first year of treatment in the enalapril group (45%) than in the valsartan group (38%) (Figure 1).


Higher persistence with valsartan compared with enalapril in daily practice.

Siiskonen SJ, Breekveldt-Postma NS, Vincze G, Khan ZM, Erkens JA, Herings RM - Vasc Health Risk Manag (2007)

Medication persistence with valsartan and enalapril treatment in the first 2 years after the index date (adjusted curves based on the Cox proportional hazard analysis). Percentage of patients still using index drug at (a) 1 year after the index date: 61.6% for valsartan and 55.0% for enalapril and (b) 2 years after the index date: 47.8% for valsartan and 43.0% for enalapril (p < 0.05).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2350122&req=5

fig1: Medication persistence with valsartan and enalapril treatment in the first 2 years after the index date (adjusted curves based on the Cox proportional hazard analysis). Percentage of patients still using index drug at (a) 1 year after the index date: 61.6% for valsartan and 55.0% for enalapril and (b) 2 years after the index date: 47.8% for valsartan and 43.0% for enalapril (p < 0.05).
Mentions: 61.6% of patients starting valsartan and 55.0% of patients starting enalapril remained on therapy with the index drug at one year after the initial dispensing. Sensitivity analyses for 1-year persistence showed that about 50% of patients starting valsartan and 45% of patients starting enalapril remained on therapy when a 30-day gap was used and about 65% of patients starting valsartan and 60% of patients starting enalapril remained on therapy when a 90 day gap was used. At two years after start, 47.8% of patients starting valsartan and 43.0% of patients starting enalapril were still using the index drug. Patients starting valsartan were 20% (1.2 times) more likely to persist with the initial therapy than patients starting enalapril at 1 and 2 years, after adjustment for differences in patient characteristics (RR1year: 1.23, 95% CI: 1.16–1.32; RR2 years: 1.16, 95% CI: 1.11–1.23) (Table 2 and Figure 1). Factors adjusted for and associated with increased persistence in the multivariate analyses were higher age, male gender, specialist as prescriber, concomitant use of other antihypertensive drugs, and previous use of concurrent cardiovascular medication as well as previous cardiovascular hospitalizations (data not shown). The lower persistence with enalapril was mainly due to higher rate of discontinuation of the drug during the first year of treatment in the enalapril group (45%) than in the valsartan group (38%) (Figure 1).

Bottom Line: About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months.Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR(adj): 1.23, 95% CI: 1.16-1.32; 2 years RR(adj): 1.16, 95% CI: 1.11-1.23).Real-life persistence is higher with valsartan than with enalapril.

View Article: PubMed Central - PubMed

Affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht,The Netherlands.

ABSTRACT

Objective: To compare persistence with valsartan and enalapril in daily practice.

Methods: The PHARMO Record Linkage System includes various data registries including drug dispensing and hospitalizations for > or =2 million subjects in the Netherlands. Patients newly treated with valsartan or enalapril in the period of 1999-2002 were selected. Persistence was calculated by summing up the number of days of continuous treatment. Patients who remained on therapy with valsartan or enalapril for 12 or 24 months were defined as persistent at 1 or 2 years, respectively.

Results: 3364 patients received valsartan and 9103 patients received enalapril. About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months. Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR(adj): 1.23, 95% CI: 1.16-1.32; 2 years RR(adj): 1.16, 95% CI: 1.11-1.23).

Conclusions: Real-life persistence is higher with valsartan than with enalapril. The results of this and other studies on persistence in daily practice should be taken into account when deciding upon drug treatment for hypertension.

Show MeSH
Related in: MedlinePlus