Hypothyroidism: Assessing Rates of Adherence to Levothyroxine

At AACE 2017, Kathleen “Kittie” Wyne, MD, PhD, The Ohio State University, discussed new data on hypothyroidism. Although hypothyroidism requires lifelong adherence to therapy, compliance still remains challenging.

The idea of the study was to look at real-life data of patients who were prescribed Synthroid or any branded levothyroxine product, and ask the questions: “Are they more likely to stay on the medication?” and “Is it branded vs. generic?”

The team was able to access a database covering over 200 million lives, of which were able to pull out almost 1 million who were on some levothyroxine product, in order to assess adherence to that prescription over the space of 1 year. Adherence was calculated by looking at whether a patient attained enough tablets to cover 80% of the days through the year.

Wyne said they first looked at the groups’ adherence total (which really wasn’t as good as they’d thought considering not even 59% continued to fill their prescription over the year). “I thought it would at least be higher in adherence, because if you look at any levothyroxine product, in this study, 6-month adherence was 60%, 12-month adherence was 48%, so that means, after a year, half the people have stopped taking it, and this is something we think of as a life-long therapy.”

She explained that many reasons could attribute to the non-compliance:

· People may have gotten started in the hospital after results from an abnormal lab test, and it’s possible the patients didn’t need the medication in the first place.

· Cost issues are probably, where people have to make monthly decisions on which prescriptions to fill

· The dose could have been too low or too high, and the patient stopped because he wasn’t feeling any better.

Regardless, providers need to assess the properties of the patients who stopped taking the medication to gain a better understanding of why they do.

Wyne did point out; however, “when you do look at adherence, it was actually highest for the Synthroid brand as compared to any other brand used. The best adherence at 6- and 12-months was Synthroid, second best was Levoxyl.”

Based on these results, Wyne suggested honing in on the patietns who were adherence to Synthroid and understanding their properties to potentially improve adherence and compliance rates in patients who need the medication. “Somehow, when they’re on Synthroid, they seem to be more likely to fill it — maybe the patients are recognizing Synthroid. Maybe various support groups are helping patients on Synthroid still to their regimen.”