Efficacy, side effects and route of administration are more important than frequency of dosing of anti-osteoporosis treatments in determining patient adherence: a critical review of published articles from 1970 to 2009

Abstract

The purposes of the study were to review available published literature on magnitude of non-adherence with osteoporosis regimens and to determine the association between frequency and modality of medication administration with patient preference and adherence. We searched peer-reviewed journal databases--MEDLINE, EMBASE, Biosis and Derwent Drug File for publications (January 1979 to January 2009) including MeSH terms--"patient preference", "adherence" and "compliance" based on "dosing frequency" and "modality". Since adherence was difficult to accurately quantify, preference, compliance and persistence were evaluated. Patients' preference and adherence at 12 months were higher with weekly over daily bisphosphonates (≥ 84% preference for weekly, medication possession ratios (MPR) 60-76% vs 46-64%; persistence 43.6-69.7% vs 31.7-55.7%). MPR reported for oral bisphosphonates were 68-71% at 12 months. At 2 years, only 43% of patients had MPR ≥ 80% for daily and weekly bisphosphonates. Observational studies (6-12 months) reported discontinuation rates of 18-22% for daily and 7% for weekly bisphosphonates. Data on monthly bisphosphonates are conflicting and confounded by cost differences, patient support programmes and definition of persistence. Studies suggest patient preference for annual zoledronic acid infusions over weekly bisphosphonates (66.4-78.8% vs 9.0-19.7%, respectively), but no data on compliance or persistence are available. Drug effectiveness, side effects and route of administration were more important than frequency. Although less frequent dosing is preferred, other factors such as perceived efficacy, side effects, medication cost, availability of patient support programmes and route of delivery are equally important. Adherence is complex and difficult to quantify and may not be exclusively influenced by frequency of medication administration.

Effect of Clodronate Treatment on Risk of Fracture: A Systematic Review and Meta-analysis

“…Despite other factors, such as drug effectiveness, adverse effects, and route of administration, are at least as important as frequency in maintaining persistency to treatment over time, there is evidence that weekly regimens may be associated with improved compliance compared with daily treatments [37]. Notably, clodronate was given in oral daily doses in 15 out of the 18 trials evaluated in the meta-analysis.…”

Development and validation of an osteoporosis treatment questionnaire (OSTREQ) evaluating physicians’ criteria in the choice of treatment

“…[26][27][28] Furthermore, there are studies evaluating questionnaires based on patients' preferences regarding osteoporosis treatment. [29][30][31][32] However, all these tools are exclusively addressed to patients. In the present study, we aimed to develop what is, to the best of our knowledge, the first questionnaire evaluating the factors that influence the physician's decision to initiate, continue or change a regimen for osteoporosis treatment.…”

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

“…Data were pooled across studies by three reviews. [128][129][130] Evidence across these reviews indicates that although patients using weekly bisphosphonate medication follow their prescribed regimens better than those using daily therapy, overall compliance and persistence rates are suboptimal for postmenopausal women receiving bisphosphonate therapy for the treatment of osteoporosis. Furthermore, one-third to one-half of patients, including men being treated with bisphosphonates for osteoporosis, did not take their medication as directed.…”

“…One review also included studies in ibandronic acid 132 and two included zoledronic acid. 130,132 The majority of reviews evaluated compliance as a MPR and persistence measured as the number of days of possession. Data were pooled across studies by three reviews.…”