COVID-19 lockdown negatively impacted on adherence to denosumab therapy: incidence of non-traumatic fractures and role of telemedicine

Abstract

Purpose Coronavirus disease (COVID-19) lockdowns have impacted on management of osteoporosis and the use of telemedicine is increasingly widespread albeit supported by little evidence so far. The aim of the study is to assess adherence to denosumab and incidence of non-traumatic fractures during the lockdown compared to the pre-COVID-19 year and to explore the effectiveness of telemedicine in the management of osteoporotic patients. Methods Retrospective, longitudinal, single-center study on patients receiving subcutaneous denosumab therapy every 6 months. Each patient was scheduled to undergo 2 visits: one during the pre-COVID-19 period (March 2019-March 2020) and another visit during the lockdown period (March 2020-March 2021). Data on new fractures, adherence, risk factors for osteoporosis and the modality of visit (telemedicine or face-to-face) were collected. ResultsThe prevalence of non-adherent patients was higher during the lockdown (35 of 269 patients, 13.0%) than the pre-COVID-19 period (9 of 276 patients, 3.3%) (p < 0.0001). During the lockdown, the number of new non-traumatic fractures was higher than the pre-COVID-19 year (p < 0.0001): 10 patients out of 269 (3.7%) experienced a fragility fracture and 2 patients (0.7%) a probable rebound fracture during the lockdown period, whereas no patient had fragility/rebound fractures during the pre-COVID-19 period. No difference was found in the prevalence of non-adherence and new non-traumatic fractures comparing patients evaluated with tele-medicine to those evaluated with face-to-face visit. Conclusion Non-adherent patients and new non-traumatic fractures (including rebound fractures) were more prevalent during the lockdown in comparison to the pre-COVID-19 period, regardless of the modality of medical evaluation.

Impact of COVID-19 Pandemic on Adherence to Chronic Therapies: A Systematic Review

“…The study of Kahn et al [18] on US national Veterans Affairs healthcare system found that the proportion of patients with inflammatory bowel disease receiving an infusion within 10 weeks of the prior infusion to infusible biologic (infliximab, inflectra, renflexis, and vedolizumab) decreased from 84.6% in 2019 to 73.6% in 2020 (p < 0.0001), with a persistent drop in the weekly number of infusions since late March 2020. De Vincentis et al [19] assessed adherence to denosumab (as a single 60 mg subcutaneous injection every 6 months) in a cohort of Italian osteoporotic patients, showing a reduction from 96,7% in the pre-COVID-19 period to 87.0% during the lockdown (p < 0.0001). They also reported that the majority of patients who were non-adherent and/or discontinued denosumab during the COVID-19 lockdown returned for regular follow-up once pandemic restrictions ceased and that the main reason of non-adherence was that patients were afraid of coming to the hospital due to the COVID-19 contagion risk.…”

“…The coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed major challenges to healthcare systems, mainly during the years 2020 and 2021. Although many countries are currently going through a transitional period, in which health systems are, at different rates, returning to pre-pandemic levels, the effects of COVID-19 pandemic were initially extremely impactful.…”

Cost-effectiveness analysis of five drugs for treating postmenopausal women in the United States with osteoporosis and a very high fracture risk

“…It should be noted that the pandemic of Coronavirus disease 19 (COVID-19) has brought some impact on the management of osteoporosis [56][57][58]. For example, the prevalence of non-adherence of denosumab was higher during the COVID-19 lockdown than before [56]. Since medicine persistence is one of the key drivers of cost effectiveness.…”

Epidemiology, course, and outcomes of Sars-CoV-2 infection in patients with acromegaly and Cushing’s disease: a monocentric experience in Southern Italy

“…Thus, the difficulties in disease management should be kept into account, during a period of recurring lockdowns when patients have been mostly managed via telemedicine, being this last modality characterized by both advantages and weak points. In fact, some studies have also demonstrated an overall lower treatment adherence during pandemic closures, although the application of remote selection criteria for face-to-face visits (i.e., triage by phone) has been proven to be useful in scheduling a more precise follow-up [ 10 , 11 ]. In addition, we aimed to verify if and how much the infection course was influenced by the typical complications of AC and CD (i.e., hypertension and metabolic issues).…”