INTRODUCTION: Clinical trials of the oral bisphosphonates have demonstrated fracture risk reduction in osteoporotic patients. To obtain this benefit in actual practice, however, patients must be adherent and persistent with therapy. This study evaluated patient adherence and persistence associated with daily and weekly dosing of the oral bisphosphonates.
METHODS: The study population was derived from a geographically diverse managed care organization utilizing medical and pharmacy administration claims. Continuously enrolled, benefit-eligible females >45 years, newly diagnosed and treated for osteoporosis with risedronate or alendronate between 7/1/2001 ¨C 12/31/2002 were identified. Two cohorts of daily and weekly users were created and followed for 12 months. Women who switched from their index dosage regimen in the follow-up were excluded. Adherence was calculated as total days of therapy / number of days of intended therapy during follow-up. Persistence was defined as % of patients receiving continuous therapy on the same drug with °Ü 45 day gap over the 12-month evaluation period.
RESULTS: 1,273 daily users and 7,092 weekly users were identified. The mean age was 63.9 ± 10.5 years. No demographic differences were observed between daily and weekly cohorts. 12-month adherence rates were 53.8% for daily and 62.5% for weekly users. Additionally, 64.5% of daily users and 52.8% of weekly users had 12-month adherence rates of less than 75%. Overall persistence rates over 12 months were 18.5% for daily and 22.1% for weekly users. The average number of months to discontinuation was 2.44 for daily and 2.55 for weekly users.
CONCLUSION: The oral bisphosphonates are associated with poor adherence and persistence, with the weekly dosing offering only marginal improvement compared to the daily regimen. Poor adherence and high levels of discontinuation with both treatment regimens likely supports the assumption that the outcomes demonstrated in clinical trials may not be achieved in real world practice.
Disclosure Information:
Faculty Member's Name: MA Omar, PhD
I have no relationships to disclose.
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