Article

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

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Mayo Clinic Proceedings (Impact Factor: 6.26). 01/2008; 82(12):1493-501. DOI: 10.1016/S0025-6196(11)61093-8
Source: PubMed

ABSTRACT

To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies.
The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance). A random-effects model was used to pool results from the selected studies.
Twenty-four studies were included in the meta-analysis. The pooled database-derived persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting 1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95% CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%) for treatment lasting more than 24 months. Pooled adherence rates decreased from 53% (95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting 7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12 months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to 6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months.
One-third to half of patients do not take their medication as directed. Nonadherence occurs shortly after treatment initiation. Terms and definitions need to be standardized to permit comparability of technologies designed to improve patient adherence. Prospective trials are needed to assess the relationship between adherence and patient outcomes.

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    • "Bisphosphonates have been shown to effectively reduce the risk of vertebral and hip fractures in osteoporotic patients. Unfortunately, several large studies have found that the majority of postmenopausal women stop bisphosphonate therapy within 1 year of beginning treatment [7] [8] [9]. Reasons for poor persistence include conflicting patient beliefs, patient preferences, financial limitations , and previous adverse effects including rash, myalgia, nausea, and diarrhea [7] [10] [11]. "
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    • "Among them, the oral bisphosphonates, including alendronate, risedronate, and ibandronate, are the most commonly used agents. However, suboptimal compliance with osteoporosis therapies is a common and well-recognized problem in the real world of clinical practice, outside of clinical trials (Cramer et al., 2007; Kothawala et al., 2007; Li et al., 2012); and poor compliance results in increased risk of fracture, higher medical costs, increases in hospitalizations, and wasted medications (Halpern et al., 2011; Sampalis et al., 2011; Ross et al., 2011; Hadji et al., 2012). Improving compliance with osteoporosis therapies is thus an important goal for both policy makers and clinicians. "
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    ABSTRACT: Purpose: The aim of this study was to estimate the rate of gastrointestinal (GI) events, and association between GI events and compliance with osteoporosis therapy among osteoporotic women. Methods: A retrospective cohort study using a large administrative claims database in the United States from 2001 through 2010 was conducted. We studied women ≥. 55. years old who were continuously enrolled in a health plan for at least 2. years, a baseline year before and a follow-up year after the date of the first prescription of oral bisphosphonate as the first oral osteoporosis treatment. Compliance with osteoporosis therapy was measured using the medication possession ratio (MPR), with compliance defined as MPR ≥. 0.8. Multivariate logistic regression was used to assess the association between occurrence of GI events and compliance with osteoporosis therapy after controlling for demographic and clinical characteristics. Results: A sample consisting of 75,593 women taking at least one oral bisphosphonate with mean (SD) age of 64 (8) years was identified. A total of 21,142 (28%) patients experienced at least one GI event during the follow-up period. Only 31,306 (41%) patients were compliant with osteoporosis therapy. Patients who experienced GI events after initiation of oral bisphosphonates were 29% less likely to adhere to osteoporosis therapy as compared to patients who did not experience GI events (odds ratio [95% CI], 0.71 [0.69-0.74]; P<.001). Conclusions: Less than half of the patients were compliant with osteoporosis therapy within one year after initiating oral bisphosphonates, and the likelihood of compliance was significantly lower by 29% among women with GI events.
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    • "Hence, the commonly used methods of measuring adherence, which classify patients as discontinued after a gap of at least 90 days even if they later restart the same therapy [11,12], or exclude patients if they switch to another anti-osteoporosis medication or different dosage [13,14], may underestimate overall treatment adherence and hinder understanding of the utilization of bisphosphonate therapy. For a study of the efficacy, effectiveness, and/or safety of a specific type, route, or dose of bisphosphonate (e.g., alendronate, risedronate, ibandronate), a narrow definition of discontinuation may be appropriate. "
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