Partial adherence: a new perspective on health economic assessment in osteoporosis

Kanis, John А.; Cooper, Cyrus; Hiligsmann, Mickaël; Rabenda, Véronique; Reginster, Jean‐Yves; Rizzoli, René

doi:10.1007/s00198-011-1668-0

Cited by 56 publications

(35 citation statements)

References 42 publications

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“…Second, our analysis highlights the importance of integrating medication adherence and persistence in pharmacoeconomic analyses conducted in osteoporosis [26 -28,30]. Poor adherence represents a new perspective on health economic assessment in osteoporosis [60], and our study may provide an interesting background for integrating medication adherence and persistence.…”

Section: Number Of Fracturesmentioning

confidence: 82%

The Clinical and Economic Burden of Poor Adherence and Persistence with Osteoporosis Medications in Ireland

et al. 2012

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Section: Number Of Fracturesmentioning

confidence: 82%

The Clinical and Economic Burden of Poor Adherence and Persistence with Osteoporosis Medications in Ireland

et al. 2012

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“…В ряде за-рубежных исследований также было показано, что низкая комплаентность лечения ПМО ассоциирует- ся не только с ослаблением прироста МПК [17], но и со снижением КЖ [4]. Кроме того, есть данные, что у НКБ возрастает риск переломов и финансовые за-траты, связанные с их лечением [4,6], однако иссле-дование этих аспектов не входило в задачи нашего исследования. Влияние терапии АН на различные аспекты КЖ больных ПМО изучалось лишь в единичных неболь-ших исследованиях [18,19].…”

Section: Discussionunclassified

“…Ис-следование МПК проводили методом двухэнергети-ческой рентгеновской абсорбциометрии в позво-ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ, 4,2014 ночном сегменте L 2 -L 4 , ПОБ total, шейке бедра и большом вертеле. Больные, включенные в исследо-вание, проводили денситометрическое исследова-ние на денситометрах, используемых в медицин-ских учреждениях, где они наблюдались.…”

Section: материал и методыunclassified

“…Низкая приверженность терапии -один из важнейших факторов, влияющих на качество лече-ния остеопороза, поскольку ассоциируется со сни-жением у больных качества жизни, повышением риска переломов и возрастанием связанных с их ле-чением затрат [4][5][6]. На приверженность терапии остеопороза существенно влияет кратность и удоб-ство приема препарата, и первым пероральным бис-фосфонатом для лечения остеопороза, у которого появилась удобная редкая кратность дозирования -1 таблетка 70 мг 1 раз в неделю, был алендронат натрия (АН), являющийся традиционным «золотым стандартом» лечения ПМО.…”

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The adherence of postmenopausal osteoporosis patients to therapy with combination medication contains alendronic acid and colecalciferol and its impact on the effectiveness of treatment

Marchenkova¹,

Древаль²,

Прохорова³

et al. 2014

Probl Endokrinol (Mosk)

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Objectives. We examined the level of persistence (remaining on therapy) and compliance (taking the medication according to directions) and its impact on the effectiveness of therapy in patients with postmenopausal osteoporosis (PMO) treating with combination medication containing 70 mg alendronic acide and 2800 IU colecalciferol - Fosavance under the supervision of medical practitioners. Material and methods. The trial was performed in the form of 2-year prospective observational multicenter study that included 373 patients with PMO aged 40-88 years, initiated therapy with Fosavance under the supervision of 20 physicians had their medical practice in Moscow (18) or Moscow region (2). Patient compliance and persistence with therapy assessed every 6 months for 2 years, the effectiveness of treatment evaluated in 2 years on the dynamics of bone mineral density (BMD) and indicators of quality of life (QOL) by the SF-36 scale. Results. 70.2% of recruited in the study PMO patients prematurely stopped therapy with Fosavance, including 41% - in the first 6 months. Among the patients who dropped out, 42.7% were lost to follow by medical practitioners, 28.6% switched to another drug therapy, 19.1% had no money to buy medication. 22.5% from 111 women who continued treatment after 2 years were non-compliant due to the high cost of therapy (52%), optionality with the purchase of the drug at the pharmacy (28%) or taking pills (16%), or lack of medication in the pharmacy (4%). There were no statistically significant differences in BMD change in compliant (CP) and non-compliant patients (NCP) in lumbar spine, trochanter and total proximal femur in 2 years. But the increase in femoral neck BMD was higher in CP vs. NCP (Δ=1.97% [-1.41; 13.3] and Δ=-2.03 [-10.4 5.20], p=0.0267). CP had greater increase in QOL by SF-36 scoring at role-physical functioning (Δ=5 points [0; 25] at CP vs. Δ=0 points [-50; 0] at NCP, p=0.0195), role-emotional functioning (Δ=50 points [0; 84] and Δ=0 points [-100; 0] respectively, p=0.0001) and social functioning (Δ=13 points [-13; 25] and Δ=-13 points [-25; 0] respectively, p=0.0048). Conclusions. Low adherence to Fosavance negative impact on the effectiveness of treatment PMO and QOL. At the initiation of therapy it's requires close interaction between the doctor and the patient, maintaining patients on regular treatment motivation and selection of the drug taking into account convenience of the reception.

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“…Definitely this work confirmed efficacy and safety of biweekly regimen, in the same way as the weekly administration, with the benefit that injections more spread over time lead to an increase of the patient's persistence. This aspect is anything but minor, considering that literature about biphosphonates clearly indicates how persistence (continuation of treatment for the entire prescribed duration) and compliance (commitment to the treatment indications) and ultimately adherence (combination of persistence and compliance) are often inadequate in the long-term treatment, with suboptimal clinical result and reduction of the cost-benefit relationship (61)(62)(63). In this respect a study on the biphosphonate use conducted on more than 35000 women (source: insurance database in the USA) followed for 2 years, proved that those with compliance lower than 50% did not benefit much from the treatment, while positive effect of the therapy showed only when compliance exceeded the threshold value of 50% (64).…”

Section: Formulations and Dosages As Antiresorptive And Anti-fracturementioning

confidence: 99%

Clodronate: new directions of use

Frediani

Bertoldi

2015

ccmbm

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SummaryClodronate is the father of bisphosphonates. For over three decades it has been subject of study in biological and clinical areas, proving to be an extremely interesting molecule from different points of view. It has been the first drug for osteoporosis that can be administered pulsatorily (once every 15 days or once a week). This, along with good tolerability, has been the first cause of its success, when there were no solid data in literature about its antifracture efficacy. There are three published studies that prove its antifracture effect: two by McCloskey published in 2004 and 2007 on BMR, and our study about fracture prevention in corticosteroids OP. In these studies a dose of 800 mg/day orally administered or 100 mg/week I.M. was used, and they are basically the same if you consider that clodronate absorption, orally administered, is on average 1.9%. However, a series of works where higher doses were used (1600 mg orally administered) with greater effectiveness on bone mass, especially in higher risk populations, lead us to consider the use of 200 mg i.m. formulation. First of all, we proved densitometric equivalence of 200 mg i.m./14 days and 100 mg i.m./week in a first study; then, in a second study, we proved a greater densitometric efficacy of 200 mg/week compared to 100 mg/week, clearer at femoral level, where the drug had not proven to prevent femoral fracture because of inadequate bone mass increase at that level. Moreover, as for ibandronate case, monthly dose was doubled compared to pivotal trial, in order to maximize the effects on femoral bone mass and therefore prevent femoral fractures. Consequently, on the basis of the risk envelope, whether it is identified according to BMD and the presence of one risk factor at least or more correctly identified through risk chart (FRAX or DeFRA), you can put forward a differential use of 100 mg i.m. and 200 mg i.m., weekly, "off-label" or every 14 days, adjusting doses in relation to fracture risk and painful symptoms gravity, as well as improving its ease of use and therefore assist compliance. Common experience and clinical and biological works have proved that clodronate has an analgesic effect that can be increased by doubling the doses. The analgesic effect is present not only with patients with fractures, but also with patients suffering from osteoarthritis or arthritis. Therefore, the drug would fit well in the therapeutic program of rheumatic patient, also because of its symptomatic effects. Clodronate at small doses (2 mg) could also have protective effects on cartilage (introduction of intra-articular formulation is expected) and at 10-100 fold higher doses it has certainly anti-inflammatory effects and more specifically antimacrophage and anticytokine effects (IL-1, IL-6, TNFalpha, PGE). These effects are amplified by putting clodronate in monolayer liposomes. This drug, therefore, has to be considered as adjuvant in arthritis therapy, whose origin can be linked to a strong osteoclastic activation caused by an increase of cytokines and...

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Partial adherence: a new perspective on health economic assessment in osteoporosis

Abstract: Partial adherence has a significant impact on cost-effectiveness. Further research is required to optimise thresholds of compliance and persistence, the impact of gap length, offset times, and fraction of benefit.

Cited by 56 publications

References 42 publications

The Clinical and Economic Burden of Poor Adherence and Persistence with Osteoporosis Medications in Ireland

The Clinical and Economic Burden of Poor Adherence and Persistence with Osteoporosis Medications in Ireland

The adherence of postmenopausal osteoporosis patients to therapy with combination medication contains alendronic acid and colecalciferol and its impact on the effectiveness of treatment

Clodronate: new directions of use

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