Adherence to long-term therapies in cystic fibrosis: a French cross-sectional study linking prescribing, dispensing, and hospitalization data

Héloïse Rouzé1,2, Marie Viprey1,2, Samuel Allemann2, Alexandra L Dima2, Pascal Caillet3, Angélique Denis1, Stéphanie Poupon-Bourdy1, Boubou Camara4, Catherine Llerena5, Philippe Reix6, Isabelle Durieu2,7, Quitterie Reynaud2,7, Sandrine Touzet1,2 1Public Health Department, Hospices Civils de Lyon, Lyon, France; 2HESPER Lab-EA 7425, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France; 3Department of Clinical Pharmacology, CHU de Nantes, Nantes, France; 4Pulmonary Department, Adult CF Center, CHU de Grenoble, Grenoble, France; 5Pediatric Pulmonology Department, Pediatric CF Center, CHU de Grenoble, Grenoble, France; 6Pediatric Pulmonology Department, Pediatric CF Center, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France; 7Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, FranceCorrespondence: Héloïse RouzéHospices Civils de Lyon, Pôle de Santé Publique, Bâtiment A, 6ème étage, 162 Avenue Lacassagne 69003 Lyon, FranceTel +33 47 211 5132Email heloise.rouze@chu-lyon.frBackground: Cystic fibrosis (CF) is a life-shortening genetic condition that usually affects several organs and involves significant treatment burden. Adherence to medication is important for successful CF management.Objective: To describe medication adherence according to age, therapeutic class, and pharmaceutical form in adults and children followed in four regional CF centers in France.Methods: We conducted a cross-sectional study with non-transplanted patients followed in two adult and two pediatric centers during 2015 who were covered by the French National Health Insurance (NHI). Sociodemographic, clinical, hospitalization, and prescription data were collected from patient medical records. Medication dispensations were extracted from the regional French NHI database. Adherence was calculated over 12 months using continuous medication availability (CMA) accounting for dose adjustments and hospitalizations. Drug-specific CMA was computed in R with the AdhereR package for each medication prescribed more than 3 months, which was averaged to obtain a composite CMA score (cCMA) for all treatments and per therapeutic class as well as pharmaceutical form for each patient.Results: A total of 228 patients were included. The number of chronic medications increased with age (r=0.50, p