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Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population.
J Stud Alcohol Drugs 2019; 80(5):572-577JS

Abstract

OBJECTIVE

U.S. Food and Drug Administration (FDA)-approved medications exist for the treatment of alcohol use disorders. However, their effectiveness depends on proper adherence to the prescribed regimen. Differences in adherence across medications may have implications for clinical outcomes and may provide helpful information in considering treatment options. This study aims to identify significant differences in adherence if present.

METHOD

A retrospective chart review was conducted in the Veterans Integrated Service Networks (VISN)-7 region of Veterans Affairs hospital and community-based outpatient clinics within South Carolina and Georgia. Prescriptions of FDA-approved alcohol use disorder medications from 2010 through 2015 were reviewed. Adherence was determined by the proportion of days the veteran had oral or injectable medication available over a 6-month period as noted by medication fills (reported as 0%-100% medication availability). We compared adherence for specific medications using chi-square, t test, logistic regression for dichotomous outcomes, and linear regression for continuous outcomes.

RESULTS

A total of 715 subjects and 807 medication trials were included. Mean adherence (percentage of days that medication was available) was 41.3% for disulfiram, 44.7% for acamprosate, 49.8% for oral naltrexone, and 54.6% for extended-release injectable naltrexone. The mean adherence was significantly different between disulfiram and oral naltrexone (p = .002) as well as disulfiram and extended-release injectable naltrexone (p = .004). Adherence of 80% was achieved in 11.9%, 19.4%, 22.7%, and 24.4% of treatment courses with disulfiram, acamprosate, naltrexone, and extended-release injectable naltrexone, respectively. These differences were significant for disulfiram versus oral naltrexone (p = .004) and disulfiram versus extended-release injectable naltrexone (p = .05).

CONCLUSIONS

These results demonstrate that overall adherence to medication-assisted treatment for alcohol use disorder is low across all medications. When directly compared, disulfiram had significantly lower adherence than both oral and extended-release injectable naltrexone.

Authors+Show Affiliations

Carolina Center for Behavioral Health, Greer, South Carolina.Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31603760

Citation

Walker, James R., et al. "Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population." Journal of Studies On Alcohol and Drugs, vol. 80, no. 5, 2019, pp. 572-577.
Walker JR, Korte JE, McRae-Clark AL, et al. Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population. J Stud Alcohol Drugs. 2019;80(5):572-577.
Walker, J. R., Korte, J. E., McRae-Clark, A. L., & Hartwell, K. J. (2019). Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population. Journal of Studies On Alcohol and Drugs, 80(5), pp. 572-577.
Walker JR, et al. Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population. J Stud Alcohol Drugs. 2019;80(5):572-577. PubMed PMID: 31603760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence Across FDA-Approved Medications for Alcohol Use Disorder in a Veterans Administration Population. AU - Walker,James R, AU - Korte,Jeffrey E, AU - McRae-Clark,Aimee L, AU - Hartwell,Karen J, PY - 2020/09/01/pmc-release PY - 2019/10/12/entrez PY - 2019/10/12/pubmed PY - 2019/10/12/medline SP - 572 EP - 577 JF - Journal of studies on alcohol and drugs JO - J Stud Alcohol Drugs VL - 80 IS - 5 N2 - OBJECTIVE: U.S. Food and Drug Administration (FDA)-approved medications exist for the treatment of alcohol use disorders. However, their effectiveness depends on proper adherence to the prescribed regimen. Differences in adherence across medications may have implications for clinical outcomes and may provide helpful information in considering treatment options. This study aims to identify significant differences in adherence if present. METHOD: A retrospective chart review was conducted in the Veterans Integrated Service Networks (VISN)-7 region of Veterans Affairs hospital and community-based outpatient clinics within South Carolina and Georgia. Prescriptions of FDA-approved alcohol use disorder medications from 2010 through 2015 were reviewed. Adherence was determined by the proportion of days the veteran had oral or injectable medication available over a 6-month period as noted by medication fills (reported as 0%-100% medication availability). We compared adherence for specific medications using chi-square, t test, logistic regression for dichotomous outcomes, and linear regression for continuous outcomes. RESULTS: A total of 715 subjects and 807 medication trials were included. Mean adherence (percentage of days that medication was available) was 41.3% for disulfiram, 44.7% for acamprosate, 49.8% for oral naltrexone, and 54.6% for extended-release injectable naltrexone. The mean adherence was significantly different between disulfiram and oral naltrexone (p = .002) as well as disulfiram and extended-release injectable naltrexone (p = .004). Adherence of 80% was achieved in 11.9%, 19.4%, 22.7%, and 24.4% of treatment courses with disulfiram, acamprosate, naltrexone, and extended-release injectable naltrexone, respectively. These differences were significant for disulfiram versus oral naltrexone (p = .004) and disulfiram versus extended-release injectable naltrexone (p = .05). CONCLUSIONS: These results demonstrate that overall adherence to medication-assisted treatment for alcohol use disorder is low across all medications. When directly compared, disulfiram had significantly lower adherence than both oral and extended-release injectable naltrexone. SN - 1938-4114 UR - https://www.unboundmedicine.com/medline/citation/31603760/Adherence_Across_FDA-Approved_Medications_for_Alcohol_Use_Disorder_in_a_Veterans_Administration_Population L2 - https://www.jsad.com/doi/abs/10.15288/jsad.2019.80.572 DB - PRIME DP - Unbound Medicine ER -