低剂量阿仑膦酸钠配合鼓励教育对骨质疏松症患者服药依从性的影响

Assessment of adherence to treatment with low-dose alendronate sodium combined with encouraging education in patients with osteoporosis

目的研究低剂量阿仑膦酸钠配合鼓励教育是否能提高骨质疏松症患者服药依从性。方法 210例已接受阿仑膦酸钠常规剂量治疗半年的骨质疏松症妇女随机分为干预组与对照组,干预组(n=105)给予低剂量阿仑膦酸钠(70 mg,2周1次)治疗;对照组(n=105)为常规剂量(70 mg,每周1次)治疗。两组均依据入组前后骨转换指标变化,教育鼓励患者坚持服药。观察两组治疗6、12、18个月时的服药顺应性、服药持续性和不良反应。运用治疗期间的药物持有率(MPR)判断患者服药顺应性,MPR≥80%为服药有顺应性;采用治疗期间开始用药至终止用药的天数表达患者服药持续性,停药间隔超过30 d判断为终止用药。结果在第12个月和18个月随访期,干预组MPR中位数均高于对照组(P<0.05)。在第6个月随访期干预组和对照组的有服药顺应性的患者比例分别为89.5%和76.2%(P=0.010);在第12个月随访期分别为73.3%和58.1%(P=0.020);在第18个月随访期分别为67.6%和48.6%(P=0.005),两组比较均有显著差异。同样,随访期第12个月和第18个月干预组持续服药天数中位数也均高于对照组,分别为360(225,360)d和360(120,360)d(P=0.030),540(225,540)d和390(120,540)d(P=0.002)。结论低剂量阿仑膦酸钠(70 mg,2周1次)口服配合鼓励教育能提高骨质疏松症患者服药依从性。

AIM To examine whether adherence to osteoporosis medications can be improved by low-dose alendronate sodium combined with encouraging education in osteoporosis. METHODS A total of 210 women with osteoporosis, been prescribed half year standard- dose alendronate sodium were randomly allocated to intervention （n = 105 ） or controls （n = 105 ）. The intervention group received low-dose alendronate sodium （70 mg every two weeks） and the control group received standard-dose alendronate sodium （70 mg weekly）. All patients received education based on the changes in bone turnover marker measurements at the beginning of alendronate sodium treatment and the intervention to encourage patient adherence to therapy. Follow- up was conducted after 6, 12 and 18 months. Medication compliance during the treatment was measured using medication possession ratio （MPR） with compliant defined as ≥ 80% of days covered. Persistence was expressed as the number of the day from initiation to eventual discontinuation of therapy. Discontinuation was defined as at least 30 days without any medication available. RESULTS The intervention group reported significantly higher median MPR at months 12 and 18 compared to the control group, P 〈 0.05. There were significant differences of patients percentage with medication compliance between two groups at 6 months （89.5% vs. 76.2%, P = 0.010）, 12 months （73.3% vs. 58.1%, P = 0.020） and 18 months （67.6% vs. 48.6%, P = 0.005） , respectively. Similarly, the median times until medication discontinuation were higher in the intervention group than the control group at 12 months （360 （interquartile range 225-360） days vs. 360 （120- 360） days, P = 0.030） and 18 months （540 （225-540） days vs. 390 （120-540） days, P = 0.002）, respectively. CONCLUSION Low-dose alendronate sodium （70 mg every two weeks） combined with encouraging education can improve the adherence in patients with osteoporosis.