Compliance, Persistence, and Preferences Regarding Osteoporosis Treatment During Active Therapy or Drug Holiday

Eliasaf, Alona; Amitai, Alina; Edry, Mira Maram; Superstine, Shimona Yosselson; Pikielny, Pnina Rotman

doi:10.1002/jcph.738

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…Four of the studies did not report a direct association between patient preference and adherence to treatment, although this can likely be explained by factors related to the individual study. Considering the studies on osteoporosis, that by Eliasaf et al reported that their study included highly motivated patients, that compliance was higher than that previously reported in the literature, and that patients on drug holiday did not have a preference for medication (25). All these factors may have had a role in the lack of significant differences.…”

Section: Discussionmentioning

confidence: 90%

“…In the study by Eliasaf et al, 80% of patients took their medication as directed (64% were on an oral medication, mostly bisphosphonates). However, in comparing treatments for osteoporosis, there was no preferred medication among patients on drug holiday (25). Freemantle carried out a 2-year randomized, crossover trial comparing subcutaneous denosumab every 6 months to oral alendronate once weekly, and reported that denosumab was associated with less nonadherence than alendronate in both years of the trial (first year, 11.9% vs. 23.4%; second year, 7.5% vs. 36.5%) (23).…”

Section: Resultsmentioning

confidence: 99%

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The role of patient preferences in adherence to treatment in chronic disease: a narrative review

Losi

Berra

Fornengo

et al. 2021

dti

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Adherence to prescribed medication is important to the management of all diseases, especially those of chronic nature. Drug effectiveness is substantially compromised by therapy nonadherence. We reviewed the available evidences on the impact of patient preferences for therapy on adherence to a prescribed treatment in chronic diseases requiring long-term treatment. A search on PubMed retrieved 699 publications, leading to a selection of 12 publications: 6 on osteoporosis, 2 on moderate-to-severe asthma, 1 on type 1 diabetes, 1 on type 2 diabetes, 1 on kidney transplantation, and 1 on atrial fibrillation. Overall, 8 studies found a positive association between patient preference and adherence to therapy, while the others found no association. In general, overall adherence was considered to be high in the published studies. The reasons for a positive association included reduced dosing frequency, route of administration, lower costs, and favorable safety profile, which is related to the diverse nature of the pathology and its type and duration of treatment. A literature review suggests that achieving good adherence and persistence to therapy requires evaluation of patient preferences. In a period of increasingly limited resources, more effort is warranted to promote better adherence to therapy, especially when patients must self-manage their disease in the long term. Our results further highlight that insufficient attention has been given to the relationship between patient preference and adherence and point out the complex nature of adherence and the need for adequate patient education. More efforts are also needed to better understand the entity of cost savings for payers for specific treatments and the link with patient preference.

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Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

The role of patient preferences in adherence to treatment in chronic disease: a narrative review

Losi

Berra

Fornengo

et al. 2021

dti

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“…Injectable medications including teriparatide, DEN, and ZOL had significantly higher persistence compared with oral medications such as raloxifene and oral bisphosphonates. 38 Injectable medications can overcome some of the disadvantages of oral medications such as cumbersome administration instructions and gastrointestinal side effects. 39 40 41 Tremblay et al’s population-based study reported persistence rates of DEN and ZOL were 63.3% and 74.8%, respectively, after two years.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS)

et al. 2022

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Background Denosumab (DEN) and zoledronic acid (ZOL) currently represent the most potent antiresorptive agents for the treatment of osteoporosis. Despite similar effects on bone resorption, these agents have distinct mechanisms of action. The objective of this study was to compare the effect of DEN and ZOL after two-year administration on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and persistence. Methods A total of 585 postmenopausal women with osteoporosis who did not use osteoporosis medications were retrospectively reviewed. 290 patients were administered 60 mg DEN subcutaneously every 6 months from 2017 to 2018, and 295 patients were treated with 5 mg ZOL intravenously yearly from 2015 to 2017. BMD, TBS, and C-terminal cross-linking telopeptide of type 1 collagen (CTX) measurements were obtained at baseline and two-year after DEN injection or ZOL infusion. Results After two-year follow-up, 188 patients in the DEN group and 183 patients in the ZOL group were compared. BMD change from baseline at two years was significantly greater in the DEN group compared with the ZOL group ( P < 0.001). The changes of TBS in the DEN group were statistically significant compared with baseline ( P < 0.001) and the ZOL group ( P < 0.001). The DEN group led to significantly greater reduction of CTX compared with ZOL group ( P = 0.041). Conclusion In postmenopausal women with osteoporosis, DEN was associated with greater BMD increase at all measured skeletal sites, greater increase of TBS, and greater inhibition of bone remodeling compared with ZOL.

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“…Such a treatment gap with respect to recommended practice (14) has been observed in many other health systems. (15)(16)(17)(18)(19)(20) In France, densitometry has been fully reimbursed since 2006, is recommended in osteoporosis practice guidelines, and is widely available. In fact, France has the highest number of densitometry machines per head of population in Europe.…”

Section: Discussionmentioning

confidence: 99%

The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

Thomas

Tubach

Bizouard

et al. 2020

Journal of Bone and Mineral Research

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Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease.

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Compliance, Persistence, and Preferences Regarding Osteoporosis Treatment During Active Therapy or Drug Holiday

Cited by 10 publications

References 29 publications

The role of patient preferences in adherence to treatment in chronic disease: a narrative review

The role of patient preferences in adherence to treatment in chronic disease: a narrative review

Comparison of Denosumab and Zoledronic Acid in Postmenopausal Women With Osteoporosis: Bone Mineral Density (BMD) and Trabecular Bone Score (TBS)

The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

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