Adherence to Nucleos(t)ide Analog Therapies in Chronic Hepatitis B: A Systematic Review
Author(s)
Javeria Khalid, MPhil, PhD1, Rajender R. Aparasu, PharmD, PhD2.
1Student, University of Houston, Houston, TX, USA, 2University of Houston, Houston, TX, USA.
1Student, University of Houston, Houston, TX, USA, 2University of Houston, Houston, TX, USA.
OBJECTIVES: Medication adherence is critical for the treatment effectiveness of nucleos(t)ide analogs in hepatitis B virus infection, as sub-optimal adherence may result in viral resistance and disease progression. This systematic review analyzed adherence rates, and the factors associated with medication adherence in observational studies involving chronic hepatitis B (CHB) patients.
METHODS: A thorough search was conducted in PubMed, Embase, and the Cochrane Library for observational studies published from inception to December 31, 2024, that reported adherence rates for a minimum of 10 CHB patients. Adherence rates along with assessment methodologies were determined. Studies involving interferon regimens or co-infected populations without disaggregated data were excluded. The risk of bias was examined with a modified prevalence evaluation technique, and heterogeneity was analyzed using the τ² statistic.
RESULTS: Out of 369 screened studies, 36 fulfilled the selection criteria. The study population included both high-income (63.8%) and low to middle-income (36.1%) countries. The average treatment adherence was 75.6% (95% CI, 68.1-83.1; τ2 = 0.16). The majority of studies (n=18) utilized self-report as the main measure of adherence. The median follow-up period was 16 months, with slightly lower adherence rates in longer follow-up. Adherence rates varied with measurement method: plasma drug levels 68.5%; medicine possession ratio-69.1%; self-report 69.5%; electronic medication dispenser 69.8%; Morisky medication adherence scale 87.0%; pharmacy claims 88.1%; pill count 73.1%; and electronic medical records 95.4%. Factors affecting optimal adherence were the cost of treatment (70%), forgetfulness (43%), and interruptions in routine (29%). Male patients and individuals undergoing monotherapy exhibit higher adherence rates.
CONCLUSIONS: Adherence with nucleos(t)ide analog treatment in CHB was sub-optimal due to variability in the measuring techniques and the heterogeneity of the studies. Concerted efforts involving targeted interventions involving financial, behavioral, and logistical issues are needed for improving medication adherence and associated long-term outcomes in CHB.
METHODS: A thorough search was conducted in PubMed, Embase, and the Cochrane Library for observational studies published from inception to December 31, 2024, that reported adherence rates for a minimum of 10 CHB patients. Adherence rates along with assessment methodologies were determined. Studies involving interferon regimens or co-infected populations without disaggregated data were excluded. The risk of bias was examined with a modified prevalence evaluation technique, and heterogeneity was analyzed using the τ² statistic.
RESULTS: Out of 369 screened studies, 36 fulfilled the selection criteria. The study population included both high-income (63.8%) and low to middle-income (36.1%) countries. The average treatment adherence was 75.6% (95% CI, 68.1-83.1; τ2 = 0.16). The majority of studies (n=18) utilized self-report as the main measure of adherence. The median follow-up period was 16 months, with slightly lower adherence rates in longer follow-up. Adherence rates varied with measurement method: plasma drug levels 68.5%; medicine possession ratio-69.1%; self-report 69.5%; electronic medication dispenser 69.8%; Morisky medication adherence scale 87.0%; pharmacy claims 88.1%; pill count 73.1%; and electronic medical records 95.4%. Factors affecting optimal adherence were the cost of treatment (70%), forgetfulness (43%), and interruptions in routine (29%). Male patients and individuals undergoing monotherapy exhibit higher adherence rates.
CONCLUSIONS: Adherence with nucleos(t)ide analog treatment in CHB was sub-optimal due to variability in the measuring techniques and the heterogeneity of the studies. Concerted efforts involving targeted interventions involving financial, behavioral, and logistical issues are needed for improving medication adherence and associated long-term outcomes in CHB.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO19
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Gastrointestinal Disorders, SDC: Infectious Disease (non-vaccine)