In a recent publication in Pharmacoepidemiology & Drug Safety, researchers aimed to gain more knowledge about adherence rates to prescription PPIs among patients with incident Barrett’s esophagus (BE) by utilizing group-based trajectory models (GBTMs).

The authors wrote, “In the United States, clinical guidelines recommend daily use of proton pump inhibitors (PPIs) amongst individuals diagnosed with Barrett's esophagus to decrease the risk of progression to dysplasia and neoplasia. Prior studies documenting adherence to PPIs in this population have not characterized heterogeneity in adherence patterns. Factors that may relate to adherence are incompletely described.”

The authors noted that assessments of PPI adherence are needed to understand whether individuals continue their prescription acid-suppression therapy longitudinally and whether clinically meaningful adherence subgroups exist. Furthermore, whether individual-level characteristics predict group membership will help understand adherence patterns, which can serve in the targeting of clinical interventions intended to enhance adherence.

Employing insurance claims data from the Merative MarketScan Commercial Claims and Encounters database between 2010 and 2019, researchers conducted a retrospective study of adherence to prescription PPIs involving a cohort of individuals who were diagnosed with incident BE aged between 18 and 64 years. GBTMs were created to detect longitudinal adherence subgroups.

The average age at BE diagnosis was 53 years, and 57% of the study cohort were male. Of the comorbidities described, gastroesophageal reflux disease (23%), hypertension (27%), and hyperlipidemia (24%) were the most commonly reported in this cohort.

In the year before BE diagnosis, 28% had received one to two additional chronic medications, 22% had filled prescriptions for three to four chronic medications, and 36% had filled prescriptions for five or more chronic medications. The remainder had not filled prescriptions for additional chronic medications.

A total of 79,701 patients with a new diagnosis of BE were included in this study. The researchers noted that the best-fitting model identified five distinct adherence patterns in the study populations in the year after obtaining a diagnosis of BE, including consistently high adherence (44% of the population), a moderate decline in adherence (18%), a slow decline in adherence (12%), a rapid decline in adherence (10%), and a decline followed by a return in adherence increase (16%).

The data revealed that compared with patients initiating PPIs, those already using PPIs were less prone to have a decreasing adherence pattern. Examples of other factors correlated with affiliation in a declining adherence group comprised (but were not limited to): female gender, having a history of past diagnosis of anxiety or depression, and having one or more visits to the emergency department in the past year.

The authors indicated that by utilizing an exploratory method, they were able to detect heterogeneity in adherence to prescription PPIs and multiple clinically distinct patterns of adherence.

Based on their findings, the authors wrote, “Our findings have implications for BE care management. Adherence to prescription PPIs is heterogeneous within the BE population. Less than half of the cohort was categorized in the consistently high adherence group, suggesting that many individuals may not receive adequate chemoprevention.”

Lastly, the authors indicated that individuals predicted to be in the fast-decline group may warrant different interventions to foster adherence than those who disengage from therapy after a period of adherence.

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