INTRODUCTION: Despite the efficacy of bisphosphonates to reduce fractures in high risk populations, bisphosphonate adherence among chronic glucocorticoid users has received limited attention. Moreover, perceived differences in GI tolerability may lead physicians to preferentially prescribe particular bisphosphonates. METHODS: Among chronic glucocorticoid users (>60 days of therapy) enrolled in managed care, we identified individuals initiating therapy with alendronate or risedronate during 2001-2004. Multivariable logistic regression and proportional hazards models were used to examine factors associated with channeling patients to risedronate (versus alendronate) and with discontinuation (>3-month gap without refill). The Medication Possession Ratio (MPR) was calculated as the filled days of medication divided by the interval of time between prescriptions. RESULTS: Of 1,158 glucocorticoid users initiating bisphosphonate therapy, demographic characteristics of alendronate users (n=754) and risedronate users (n=404) were similar for age (mean 53 years) and gender (approximately 80% female). Past history of a GI symptom or event was associated with risedronate receipt (OR=2.24, 95% CI 1.15-4.35). After multivariable adjustment, rates of discontinuation (mean time to discontinuation approximately 18 months) and adherence (mean MPR=73%) were similar between users of the two bisphosphonates. Younger age, greater medical comorbidity, and lack of BMD testing were significantly associated with discontinuation. CONCLUSIONS: Overall persistence rates were suboptimal for bisphosphonate use among chronic glucocorticoids users and did not differ significantly by drug. Newer strategies to promote long-term adherence are needed to improve osteoporosis therapeutic effectiveness.
INTRODUCTION: Despite the efficacy of bisphosphonates to reduce fractures in high risk populations, bisphosphonate adherence among chronic glucocorticoid users has received limited attention. Moreover, perceived differences in GI tolerability may lead physicians to preferentially prescribe particular bisphosphonates. METHODS: Among chronic glucocorticoid users (>60 days of therapy) enrolled in managed care, we identified individuals initiating therapy with alendronate or risedronate during 2001-2004. Multivariable logistic regression and proportional hazards models were used to examine factors associated with channeling patients to risedronate (versus alendronate) and with discontinuation (>3-month gap without refill). The Medication Possession Ratio (MPR) was calculated as the filled days of medication divided by the interval of time between prescriptions. RESULTS: Of 1,158 glucocorticoid users initiating bisphosphonate therapy, demographic characteristics of alendronate users (n=754) and risedronate users (n=404) were similar for age (mean 53 years) and gender (approximately 80% female). Past history of a GI symptom or event was associated with risedronate receipt (OR=2.24, 95% CI 1.15-4.35). After multivariable adjustment, rates of discontinuation (mean time to discontinuation approximately 18 months) and adherence (mean MPR=73%) were similar between users of the two bisphosphonates. Younger age, greater medical comorbidity, and lack of BMD testing were significantly associated with discontinuation. CONCLUSIONS: Overall persistence rates were suboptimal for bisphosphonate use among chronic glucocorticoids users and did not differ significantly by drug. Newer strategies to promote long-term adherence are needed to improve osteoporosis therapeutic effectiveness.
Authors: Jeffrey R Curtis; Andrew O Westfall; Jeroan Allison; Allison Freeman; Stacey H Kovac; Kenneth G Saag Journal: Pharmacoepidemiol Drug Saf Date: 2006-10 Impact factor: 2.890
Authors: T Schnitzer; H G Bone; G Crepaldi; S Adami; M McClung; D Kiel; D Felsenberg; R R Recker; R P Tonino; C Roux; A Pinchera; A J Foldes; S L Greenspan; M A Levine; R Emkey; A C Santora; A Kaur; D E Thompson; J Yates; J J Orloff Journal: Aging (Milano) Date: 2000-02
Authors: S T Harris; N B Watts; H K Genant; C D McKeever; T Hangartner; M Keller; C H Chesnut; J Brown; E F Eriksen; M S Hoseyni; D W Axelrod; P D Miller Journal: JAMA Date: 1999-10-13 Impact factor: 56.272
Authors: Anna N A Tosteson; Margaret R Grove; Cristina S Hammond; Megan M Moncur; G Thomas Ray; Gwen M Hebert; Alice R Pressman; Bruce Ettinger Journal: Am J Med Date: 2003-08-15 Impact factor: 4.965
Authors: Carmen Turbí; Gabriel Herrero-Beaumont; Juan Carlos Acebes; Antonio Torrijos; Jenaro Graña; Roberto Miguélez; JoséAntonio Sacristán; Fernando Marín Journal: Clin Ther Date: 2004-02 Impact factor: 3.393
Authors: S M Cadarette; J N Katz; M A Brookhart; T Stürmer; M R Stedman; R Levin; D H Solomon Journal: Osteoporos Int Date: 2009-03-06 Impact factor: 4.507
Authors: Jeffrey R Curtis; Andrew O Westfall; Hong Cheng; Kenneth Lyles; Kenneth G Saag; Elizabeth Delzell Journal: J Bone Miner Res Date: 2008-09 Impact factor: 6.741
Authors: E Barrett-Connor; K Ensrud; A N A Tosteson; S F Varon; M Anthony; N Daizadeh; S Wade Journal: Osteoporos Int Date: 2008-07-08 Impact factor: 4.507