Persistence at 1 year of oral antiosteoporotic drugs: a prospective study in a comprehensive health insurance database

Abstract

Objective: Treatments against osteoporosis have demonstrated fracture risk reduction but persistence to therapy remains a major issue. Intermittent regimens have been developed to improve persistence. The aim of this 1-year prospective study was to compare, in the general population, the persistence of various oral regimens of antiosteoporotic treatment. Methods: We conducted this prospective study in the French comprehensive public health insurance database of the Rhône-Alpes region. Women aged 45 years or older who had a first reimbursement of an oral antiosteoporotic treatment during February 2007 composed the study cohort. Persistence was defined by the proportion of patients refilling a prescription in the pharmacist delivery register (ERASME). Using statistical analyses like Kaplan-Meier survival curves and log-rank tests, we compared the treatment persistence of strontium ranelate, raloxifene, and daily-, weekly-, and monthly bisphosphonates. Results: Two thousand four hundred and nineteen patients were included over a period of 1 month and followed up for 12 months. Two hundred and eighty-nine (11.9%) patients were treated with monthly bisphosphonates, 1298 (53.7%) with weekly bisphosphonates, and 832 (34.4%) with daily treatments (526 strontium ranelate (21.7%), 296 raloxifene (12.2%), and 10 bisphosphonates (0.4%)). At 1 year, overall persistence was 34%. Fifty percent of patients on monthly bisphosphonates were still persistent while only 37% of patients on weekly bisphosphonates, 34% on raloxifene, and 16% on strontium ranelate were persistent. Therapy monitoring with biochemical markers or bone mineral density was associated with improved persistence. Conclusion: Overall persistence at 1 year was low, but intermittent regimens were associated with higher persistence rates, along with women who had therapy monitoring.

A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary

“…Therefore, data on persistence need to be evaluated in the context of the latest evidence and recommendations for osteoporosis drug use. Our findings for persistence were generally consistent with other database studies [12,28,36]. For example, among 2419 postmenopausal women in France [36], 1-year persistence with orally administered anti-osteoporosis medications was 34 %, compared with 32 % for oral medications in the current study.…”

“…Our findings for persistence were generally consistent with other database studies [12,28,36]. For example, among 2419 postmenopausal women in France [36], 1-year persistence with orally administered anti-osteoporosis medications was 34 %, compared with 32 % for oral medications in the current study. Similarly to findings from our study, 1-year persistence varied significantly according to the administration frequency; however, compared with weekly therapies, monthly dosing was associated with significantly improved persistence and the daily regimens were associated with significantly poorer persistence [36].…”

Use of an educational support program to assist patients receiving injectable osteoporosis treatment: experience with teriparatide

“…Although there are currently many drugs that have proven their effectiveness in reducing fractures 2,3 , adherence and persistence to osteoporosis treatments are very low [4][5][6][7][8][9] . This finding is in spite of the availability of simplified dosage schedules and management guidelines 2, [10][11][12][13][14] , and the results of many studies that have identified factors affecting adherence and persistence 5,15 .…”

“…Therefore, because of the low adherence rates with osteoporosis treatments identified in the literature [4][5][6][7][8][9] , an educational program for the use of the teriparatide (Forsteo, Eli Lilly and Company, Alcobendas, Spain) delivery device was developed and implemented by International SOS. The aim of this ongoing program is to achieve proper handling and use of the delivery device by those patients prescribed teriparatide by their physicians.…”

Persistance du traitement et évolution du risque de fracture, des douleurs rachidiennes et de la qualité de vie chez les patients traités par du tériparatide en pratique clinique de routine en France : résultats de l’étude observationnelle européenne Forsteo

“…La plupart des femmes semblent arrêter le téripara-tide après environ 18 mois, comme pour la cohorte entière EFOS [15,21] et comme d'autres études d'observation au Canada [22], au Royaume-Uni [23] et en France [24]. Fait intéressant, la persistance des traitements par tériparatide était plus élevée que celle des antirésorptifs par voie orale, même avec des doses hebdomadaires ou mensuelles [25][26][27], peut-être en partie à cause de la gravité de l'ostéoporose et de la participation de certains patients franç ais à un programme éducatif. Ce résultat est important car la persistance est associée à la santé des patients.…”