Persistence with tamoxifen and aromatase inhibitors in Germany: a retrospective cohort study with 284,383 patients

Abstract

Purpose The aim of this study was to analyze the persistence of women on tamoxifen (TAM) and aromatase inhibitors (AIs) in Germany, and to investigate possible determinants of non-persistence. Methods The present retrospective cohort study was based on the IQVIA longitudinal prescription database (LRx). The study included women with an initial prescription of TAM or AIs (anastrozole, letrozole, and exemestane) between January 2016 and December 2020 (index date). Kaplan–Meier analyses were performed to show the persistence for TAM and AI, using a therapy gap of 90 or 180 days, respectively. A multivariable Cox proportional hazards regression model was further used to estimate the relationship between non-persistence and drug prescription (AI versus TAM), age, and the specialty of the physician initiating therapy (gynecologist, oncologist, or general practitioner). Results Up to 5 years after the index date, only 35.1% of AI and 32.5% of TAM patients were continuing therapy when therapy discontinuation was defined as at least 90 days without therapy. Using a 180-day therapy gap, 51.9% of AI and 50.4% of TAM patients remained on therapy after 5 years. Cox regression models reveal that initial therapy with TAM (HR 1.06, 95% CI 1.04–1.07), therapy initiation by oncologists (HR 1.09, 95% CI 1.07–1.11), or general practitioners (HR 1.24, 95% CI 1.21–1.27) and age ≤ 50 (HR 1.08, 95% CI 1.06–1.10) were significantly associated with an increased risk of therapy discontinuation. Conclusion Overall, the present study indicates that persistence rates are low in all age groups for both TAM and AI treatment. We found several factors (e.g., physician specialty, younger age, and type of endocrine therapy) to be associated with an increased risk for non-persistence.

Initiation of Antiresorptive Drug Treatment during Endocrine Therapy for Breast Cancer—A Retrospective Cohort Study of 161,492 Patients in Germany

“…In particular, we can also show that the majority of BC patients under ET were treated by gynecologists, followed by oncologists and general practitioners ( Table 1 ). In fact, in Germany, BC patients are generally treated by gynecologists rather than oncologists and general practitioners, with gynecologists receiving special training and regular updates regarding BC treatment [ 27 ]. In view of the complex issue of ET and bone health, a multidisciplinary management approach together with bone specialists may be necessary to implement the latest guideline recommendations in clinical practice.…”

“…However, it does not include information on diagnoses or laboratory tests [ 26 ]. Previous studies on pharmacoepidemiology have also utilized this database [ 27 , 28 ].…”

Association between gout and subsequent breast cancer: a retrospective cohort study including 67,598 primary care patients in Germany

“…In Germany, approximately 68,950 women were diagnosed with BC in 2016 and 18,570 women died of the disease [2]. The number of BC cases worldwide is expected to increase to 2.7 million annually by 2030 [3][4][5]. Notably it has been estimated that about 20% of all BC-related deaths can be attributed to modifiable risk factors such as alcohol use, obesity (BMI ≥ 30), and reduced physical activity [6].…”

Unlocking the potential of aromatase inhibitors: recent advances in drug design, synthesis, docking activity, and in vitro bioactivity evaluations

“…Consequently, artificial intelligence is used in breast cancer therapy [10]. Aromatase inhibitors may be divided into two subtypes, steroidal and nonsteroidal [4,11] .Non-Steroidal Aromatase Inhibitors (NSAIs), such as anastrozole and letrozole, block the action of the aromatase enzyme to reduce estrogen levels in postmenopausal women, while Steroidal Aromatase Inhibitors, exemplified by exemestane, irreversibly bind to the aromatase enzyme to inhibit its activity and lower estrogen production in postmenopausal women with hormone receptor-positive breast cancer [4,12,13]. There is another classification for aromatase inhibitors: first, second and third generation [14].…”