Abstract
Background:The effectiveness of chronic therapies can be compromised by poor adherence and persistence. Materials and Methods:Investigators identified a continuously benefit-eligible cohort of women from a large, geographically diverse, national managed care plan who were newly diagnosed and treated for osteoporosis with alendronate, risedronate, or raloxifene. Drug utilization parameters were evaluated over a 12-month follow-up period for the study population. Adherence was assessed using a medication possession ratio calculated as total days of therapy for medication dispensed/365 days of study follow-up. Persistence was defined as continuous therapy on the same drug for each month over the entire study period. Adherence and persistence were also evaluated for all three study agents in women ≥65 years of age. Results:In the study cohort (N = 10,566), 12-month adherence/persistence rates were alendronate 61%/21%, risedronate 58%/19%, and raloxifene 54%/16%. Rates in women ≥65 years were similar to those in the entire study cohort. Weekly bisphosphonate users had slightly higher 12-month adherence (63% versus 54%, P < 0.05) and persistence (22% versus 19%, P = NS) rates than did daily users, independent of agent. Conclusion:Chronic oral-dosed osteoporosis therapies are associated with poor adherence and persistence, regardless of age or dosing regimen. Drug therapies and patient management approaches associated with improved adherence and persistence could improve the likelihood of achieving the therapeutic benefits observed in rigorously controlled clinical trials.
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References
References1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001;285:785–795.NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and TherapyOsteoporosis prevention, diagnosis, and therapy.JAMA2001285785-795 2. Iqbal MM. Osteoporosis: epidemiology, diagnosis, and treatment. South Med J 2000;93:2–18.IqbalMMOsteoporosis: epidemiology, diagnosis, and treatment.South Med J2000932-18 3. National Osteoporosis Foundation Fast Facts. Available at: http://www.nof.org/osteoporosis/diseasefacts.htm. Accessed October 16, 2005. 4. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville,, MD: US Dept of Health and Human Services, Public Health Service, Office of the Surgeon General; 2004.&NA;Bone Health and Osteoporosis: A Report of the Surgeon General.Rockville,, MDUS Dept of Health and Human Services, Public Health Service, Office of the Surgeon General2004 5. McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004;48:271–287.McCombsJS]]ThiebaudP]]McLaughlin-MileyC]]ShiJCompliance with drug therapies for the treatment and prevention of osteoporosis.Maturitas200448271-287 6. Tosteson AN, Grove MR, Hammond CS, et al. Early discontinuation of treatment for osteoporosis. Am J Med 2003;115:209–216.TostesonAN]]GroveMR]]HammondCS&etal;Early discontinuation of treatment for osteoporosis.Am J Med2003115209-216 7. Lufkin EG, Whitaker, MD, Nickelsen T, et al. Treatment of established postmenopausal osteoporosis with raloxifene: a randomized trial. J Bone Miner Res 1998;13:1747–1754.LufkinEG]]WhitakerMD]]NickelsenT&etal;Treatment of established postmenopausal osteoporosis with raloxifene: a randomized trial.J Bone Miner Res1998131747-1754 8. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial: Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282:637–645.EttingerB]]BlackDM]]MitlakBH&etal;Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial: Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators.JAMA1999282637-645 9. Eastell R, Barton I, Hannon RA, et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003;18:1051–1056.EastellR]]BartonI]]HannonRA&etal;Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate.J Bone Miner Res2003181051-1056 10. Bauer DC, Black DM, Garnero P. Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial. J Bone Miner Res 2004;19:1250–1258.BauerDC]]BlackDM]]GarneroPChange in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: the fracture intervention trial.J Bone Miner Res2004191250-1258 11. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 1996;348:1535–1541.BlackDM]]CummingsSR]]KarpfDB&etal;Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group.Lancet19963481535-1541 12. Sorensen OH, Crawford GM, Mulder H, et al. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003;32:120–126.SorensenOH]]CrawfordGM]]MulderH&etal;Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience.Bone200332120-126 13. Greenspan S, Field-Munves E, Tonino R, et al. Tolerability of once-weekly alendronate in patients with osteoporosis: a randomized, double-blind, placebo-controlled study. Mayo Clin Proc 2002;77:1044–1052.GreenspanS]]Field-MunvesE]]ToninoR&etal;Tolerability of once-weekly alendronate in patients with osteoporosis: a randomized, double-blind, placebo-controlled study.Mayo Clin Proc2002771044-1052 14. Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004;89:1117–1123.ClowesJA]]PeelNF]]EastellRThe impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial.J Clin Endocrinol Metab2004891117-1123 15. Ettinger B, Schein J, Pressman A, et al. Alendronate use among 812 women: prevalence of gastrointestinal complaints, noncompliance with patient instructions, and discontinuation. J Manag Care Pharm 1998;4:488–492.EttingerB]]ScheinJ]]PressmanA&etal;Alendronate use among 812 women: prevalence of gastrointestinal complaints, noncompliance with patient instructions, and discontinuation.J Manag Care Pharm19984488-492 16. Hamilton B, McCoy K, Taggart H. Tolerability and compliance with risedronate in clinical practice. Osteoporos Int 2003;14:259–262.HamiltonB]]McCoyK]]TaggartHTolerability and compliance with risedronate in clinical practice.Osteoporos Int200314259-262 17. Kayser J, Ettinger B, Pressman A. Postmenopausal hormonal support: discontinuation of raloxifene versus estrogen. Menopause 2001;8:328–332.KayserJ]]EttingerB]]PressmanAPostmenopausal hormonal support: discontinuation of raloxifene versus estrogen.Menopause20018328-332 18. Faulkner DL, Young C, Hutchins D, et al. Patient noncompliance with hormone replacement therapy: a nationwide estimate using a large prescription claims database. Menopause 1998;5:226–229.FaulknerDL]]YoungC]]HutchinsD&etal;Patient noncompliance with hormone replacement therapy: a nationwide estimate using a large prescription claims database.Menopause19985226-229 19. Yood RA, Emani S, Reed JI, et al. Compliance with pharmacologic therapy for osteoporosis. Osteoporos Int 2003;14:965–968.YoodRA]]EmaniS]]ReedJI&etal;Compliance with pharmacologic therapy for osteoporosis.Osteoporos Int200314965-968 20. Papaioannou A, Ioannidis G, Adachi JD, et al. Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database. Osteoporos Int 2003;14:808–813.PapaioannouA]]IoannidisG]]AdachiJD&etal;Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database.Osteoporos Int200314808-813 21. Watts NB, Worley K, Solis A, et al. Comparison of risedronate to alendronate and calcitonin for early reduction of nonvertebral fracture risk: results from a managed care administrative claims database. J Manag Care Pharm 2004;10:142–151.WattsNB]]WorleyK]]SolisA&etal;Comparison of risedronate to alendronate and calcitonin for early reduction of nonvertebral fracture risk: results from a managed care administrative claims database.J Manag Care Pharm200410142-151 22. Turbi C, Herrero-Beaumont G, Acebes JC, et al. Compliance and satisfaction with raloxifene versus alendronate for the treatment of postmenopausal osteoporosis in clinical practice: an open-label, prospective, nonrandomized, observational study. Clin Ther 2004;26:245–256.TurbiC]]Herrero-BeaumontG]]AcebesJC&etal;Compliance and satisfaction with raloxifene versus alendronate for the treatment of postmenopausal osteoporosis in clinical practice: an open-label, prospective, nonrandomized, observational study.Clin Ther200426245-256 23. Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005;80:856–861.ReckerRR]]GallagherR]]MacCosbePEEffect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women.Mayo Clin Proc200580856-861 24. Cramer JA, Amonnkar MM, Hebborn A, et al. Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 2005;21:1453–1460.CramerJA]]AmonnkarMM]]HebbornA&etal;Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis.Curr Med Res Opin2005211453-1460 25. Ettinger MP. Aging bone and osteoporosis. strategies for preventing fractures in the elderly. Arch Intern Med 2003;163:2237–2246.EttingerMPAging bone and osteoporosis. strategies for preventing fractures in the elderly.Arch Intern Med20031632237-2246 26. Sebaldt RJ, Shane LG, Pham B, et al. Longer term effectiveness outcomes of noncompliance and nonpersistence with daily regimen bisphosphonate therapy in patients with osteoporosis treated in tertiary specialist care. Osteoporos Int 2004;15 (Suppl 1):S107. Abstract P391SA. 27. Caro JJ, Ishak KJ, Huybrechts KF, et al. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 2004;15:1003–1008.CaroJJ]]IshakKJ]]HuybrechtsKF&etal;The impact of compliance with osteoporosis therapy on fracture rates in actual practice.Osteoporos Int2004151003-1008 28. Siris ES, Rosen CJ, Bangor ME, et al. Adherence to bisphosphonate therapy: relationship to bone fractures at 24 months in women with postmenopausal osteoporosis. Presented at the Sixth International Symposium on Osteoporosis; April 6–10, 2005; Washington, DC.
