J Am Acad Dermatol :异维A酸治疗:完成率与不依从性相关因素的回顾性队列分析

2018-11-13 程波 福建医科大学附属第一医院 CSDCMA资讯平台

在过去的十年中,抗癌治疗引起的治疗转归和皮肤毒性之间的关系得到了关注。在本文中,我们概述了3类主要的抗癌药物,特别是分子靶向激酶抑制剂,免疫检查点抑制剂和细胞毒性化疗药物,并描述了这些药物引起的皮肤毒性与生存获益之间关系的数据。虽然关于皮肤毒性可作为治疗效果的替代生物标志物的初步研究有前景,但需要更大的前瞻性研究来证实这种关系。通过帮助确认和管理癌症患者的这些皮肤问题,皮肤科医生有特殊的机会与肿瘤

致编辑:药物治疗的不依从性仍然是痤疮治疗失败的主要原因,也是皮肤科医生在治疗痤疮患者时遇到的主要挑战1-3。异维甲酸诱导疾病缓解具有剂量依赖性,坚持治疗尤其重要,然而关于这个主题的文献较少3,4。报道异维甲酸治疗第一个疗程的依从率为54%-96%1,2,5。我们的目的是调查维甲酸治疗依从性,并探讨常见的不依从原因。

我们对2010-2015年间加州大学洛杉矶皮肤科诊所544名开具了异维甲酸处方的患者进行了回顾性图表分析,并获得了机构审查委员会的批准。排除标准包括医疗记录不完整或访问限制,慢性低剂量或替代治疗,以及非痤疮诊断。依从性被定义为达到累积剂量120-150mg/kg或由治疗临床医师确定的治疗完成4。根据该定义,患者被分成6大类:完成、可能完成、失访(LTFU)、患者自行停药、医生医嘱停药,或者从未开始。

总之, 458名患者(50.4%为女性)被纳入此分析。其中,53.9%完成治疗,18.3%几乎完成了治疗,15.5% 失访,5.9%根据医生医嘱停药,4.2%自主决定停药,还有3.1%从未开始治疗。

在排除从未开始组和医生医嘱停药组之后,我们发现总的依从率为78.6%,将完成组和可能完成的组计算为依从组,而LTFU和患者自行停药组计算为不依从组。

比较依从患者和不依从患者,在年龄、性别或既往异维甲酸的治疗过程状态上没有统计学上的显着差异。然而,当失访患者与依从患者比较,更多失访患者是男性,更多失访患者曾有过≥1次异维甲酸用药史(分别的P值为0.03和0.04)(表1)。大多数不依从的病人没有完成治疗,仅仅是因为没有回到诊所进行随访预约;超过三分之一的患者在开始治疗后没有完成第一次随访预约(图1)。

点击查看原图

临床和逻辑因素导致药物治疗不依从。医生停止医嘱和患者自行停药最常见的原因是情绪变化。自行停药的其他原因包括旅行/搬家/不愿意减少酒精摄入量。最常见的未开始治疗的原因是iPLEDGE的困难。在133名完成治疗的女性患者中,只有61.7%的患者接受了治疗后30天的妊娠检查。年龄和治疗前状况对最后一次妊娠检查的影响没有统计学意义。

本研究的优势在于大量的患者仅使用异维甲酸治疗,以及不同亚组不依从患者的特征和评价。这项研究是一项回顾性研究,因此我们寻找、分析患者失访原因的能力收到了限制。

根据我们的研究结果,我们建议改进对可能无法遵守iPLEDGE要求的患者的筛查和教育,并密切关注提高第一个月随访率(通过电话和短信提醒),这可能对增加异维甲酸治疗的成功启动和完成至关重要。未来的研究可以评估这些干预措施实施后的依从率。

原始出处:

Kazemi T, Sachsman S M, Wilhalme H M, et al. Isotretinoin Therapy: A Retrospective Cohort Analysis of Completion Rates and Factors Associated with Non-Adherence[J]. Journal of the American Academy of Dermatology, 2018.

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    2019-08-19 膀胱癌
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    2019-10-17 lishizhe
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    2018-11-15 fyxzlh
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