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Research ArticleArticle

Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization

Dana Ben-Ami Shor, Dahlia Weitzman, Shani Dahan, Omer Gendelman, Yael Bar-On, Daniela Amital, Varda Shalev, Gabriel Chodick and Howard Amital
The Journal of Rheumatology August 2017, jrheum.170098; DOI: https://doi.org/10.3899/jrheum.170098
Dana Ben-Ami Shor
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Dahlia Weitzman
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Shani Dahan
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Omer Gendelman
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Yael Bar-On
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Daniela Amital
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Varda Shalev
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Gabriel Chodick
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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Howard Amital
From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel. Supported by a research grant given by Pfizer. D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work. Address correspondence to Dr. H. Amital, Department of Medicine B, Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mail: howard.amital@sheba.health.gov.il. Accepted for publication May 26, 2017.
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  • Errata - November 01, 2017

Abstract

Objective To assess 1-year persistence and adherence rates with drug therapy among patients with fibromyalgia (FM) and to identify factors associated with therapy discontinuation.

Methods This retrospective, cohort study included members ≥ 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. Medications of interest included the anticonvulsant pregabalin, antidepressants [selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)], and tricyclic antidepressants (TCA). Time to treatment discontinuation and proportion of days covered (PDC) with FM-specific therapies during the year from first dispensed were analyzed. PDC < 20% was considered low adherence and PDC ≥ 80% was considered high adherence. Logistic regression models were constructed for multivariable analyses.

Results Overall, 3932 patients with FM were included; 88.7% were female. Pre-diagnosis use of medication of interest was documented in 41% of the study population. Of the remaining 2312 patients, 56.1% were issued a prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis. Among newly prescribed patients, 1-year discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC ≥ 80%).

Conclusion This study clearly shows that in an Israeli “real-life” population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low.

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Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization
Dana Ben-Ami Shor, Dahlia Weitzman, Shani Dahan, Omer Gendelman, Yael Bar-On, Daniela Amital, Varda Shalev, Gabriel Chodick, Howard Amital
The Journal of Rheumatology Aug 2017, jrheum.170098; DOI: 10.3899/jrheum.170098

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Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization
Dana Ben-Ami Shor, Dahlia Weitzman, Shani Dahan, Omer Gendelman, Yael Bar-On, Daniela Amital, Varda Shalev, Gabriel Chodick, Howard Amital
The Journal of Rheumatology Aug 2017, jrheum.170098; DOI: 10.3899/jrheum.170098
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