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Persistence and switching patterns among women with varied osteoporosis medication histories: 12-month results from POSSIBLE US™

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Abstract

Summary

During the first year of Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBE US™), many women transitioned (i.e., discontinued or switched) from their baseline osteoporosis medication. Participants not on stable therapy at entry, with side effects, and with poor physical status were at higher risk of transitioning. Understanding factors associated with persistence may lead to improved outcomes.

Introduction

Postmenopausal osteoporosis (PMO) medication use patterns may differ by treatment history and drug class. We describe these patterns among patients in primary care settings using patient-reported data.

Methods

Data from 3,006 participants of the POSSIBLE US™ were used to estimate the probability of a baseline PMO medication transition (i.e., discontinuation or switch) and hazard ratios (HRs) for predictors of these transitions.

Results

One year after study entry, the probability of persisting with a baseline medication was 66% (95% CI: 64–68%). After adjusting for age and osteoporosis diagnosis, factors at entry independently associated with a higher risk of baseline medication transition were treatment status cohort, side effect severity, and OPAQ-SV physical function score. Compared to participants stable on therapy at entry, others had a higher risk, ranging from HR = 1.59 (95% CI: 1.36–1.85) for those new to therapy to HR = 2.00 (95% CI: 1.27–3.15) for those who recently augmented therapy at entry. Participants reporting moderate (HR = 1.31, 95% CI: 1.09–1.57) or severe (HR = 1.88, 95% CI: 1.49–2.39) side effects had a higher risk than those not reporting side effects. Participants reporting Osteoporosis Assessment Questionnaire-Short Version physical function scores in the lowest tertile had a higher risk (HR = 1.27, 95% CI: 1.07–1.52) than those reporting scores in the highest tertile.

Conclusion

Baseline osteoporosis medication transitions were common in the first year of POSSIBLE US™. Participants not on stable therapy at entry, or who reported severe side effects, or had poor physical health status were at higher risk for these transitions.

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References

  1. Fletcher SW, Colditz GA (2002) Failure of estrogen plus progestin therapy for prevention. JAMA 288:366–368

    Article  PubMed  Google Scholar 

  2. Rossouw JE (2002) Effect of postmenopausal hormone therapy on cardiovascular risk. J Hypertens Suppl 20:S62–S65

    CAS  PubMed  Google Scholar 

  3. Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ (2007) Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc 82:1493–1501

    Article  PubMed  Google Scholar 

  4. Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031

    Article  CAS  PubMed  Google Scholar 

  5. Downey TW, Foltz SH, Boccuzzi SJ, Omar MA, Kahler KH (2006) Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. South Med J 99:570–575

    Article  PubMed  Google Scholar 

  6. Rossini M, Bianchi G, Di MO, Giannini S, Minisola S, Sinigaglia L, Adami S (2006) Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 17:914–921

    Article  CAS  PubMed  Google Scholar 

  7. Kayser J, Ettinger B, Pressman A (2001) Postmenopausal hormonal support: discontinuation of raloxifene versus estrogen. Menopause 8:328–332

    Article  CAS  PubMed  Google Scholar 

  8. Barrett-Connor E, Ensrud K, Tosteson AN, Varon SF, Anthony M, Daizadeh N, Wade S (2009) Design of the POSSIBLE US™ Study: postmenopausal women's compliance and persistence with osteoporosis medications. Osteoporos Int 20:463–472

    Article  CAS  PubMed  Google Scholar 

  9. Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR (2004) Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes 2:12

    Article  PubMed  Google Scholar 

  10. Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72

    Article  CAS  PubMed  Google Scholar 

  11. Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire. J Rheumatol 25:1171–1179

    CAS  PubMed  Google Scholar 

  12. Gallagher AM, Rietbrock S, Olson M, van Staa TP (2008) Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 23:1569–1575

    Article  PubMed  Google Scholar 

  13. Cotte FE, Mercier F, De PG (2008) Relationship between compliance and persistence with osteoporosis medications and fracture risk in primary health care in France: a retrospective case-control analysis. Clin Ther 30:2410–2422

    Article  PubMed  Google Scholar 

  14. Siris ES, Selby PL, Saag KG, Borgstrom F, Herings RM, Silverman SL (2009) Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 122:S3–S13

    Article  PubMed  Google Scholar 

  15. Burge R, wson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  16. Tosteson AN, Grove MR, Hammond CS, Moncur MM, Ray GT, Hebert GM, Pressman AR, Ettinger B (2003) Early discontinuation of treatment for osteoporosis. Am J Med 115:209–216

    Article  PubMed  Google Scholar 

  17. McHorney CA, Schousboe JT, Cline RR, Weiss TW (2007) The impact of osteoporosis medication beliefs and side-effect experiences on non-adherence to oral bisphosphonates. Curr Med Res Opin 23:3137–3152

    Article  CAS  PubMed  Google Scholar 

  18. Ideguchi H, Ohno S, Takase K, Ueda A, Ishigatsubo Y (2008) Outcomes after switching from one bisphosphonate to another in 146 patients at a single university hospital. Osteoporos Int 19:1777–1783

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the other members of the POSSIBLE US™ Steering Committee: Elizabeth Barrett-Connor, Ted Ganiats, Marc Hochberg, Barbara Lukert, Robert Recker, Robert Rubin, and David Macarios. In addition, we are grateful for the methodologic and data analysis contributions of Mike Gao, Aalok Nadkar, Michael Damiata, and Richard Baumann. We would also like to acknowledge the REGISTRAT, Inc. staff that assisted with the implementation of this study and ongoing data collection as well as Michelle N Bradley of Amgen Inc. who provided editorial assistance. Funding for this study was provided by Amgen Inc., Thousand Oaks, CA USA.

Conflicts of interest

This study was funded by Amgen Inc., Thousand Oaks, CA, USA. Anna Tosteson provides consulting services to Amgen Inc. and Eli Lilly & Co. Thy P Do and Mary S Anthony are employees of Amgen Inc. Sally Wade provides consulting services to Amgen Inc. Robert W Downs receives research funding from and provides consulting services to Amgen Inc. The authors agree to allow the journal to review the primary data if requested.

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Authors and Affiliations

  1. HB 7505 Clinical Research, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH, 03756, USA

    A. N. A. Tosteson

  2. Amgen Inc, 1201 Amgen Court West, MS: WAWM 1111, Seattle, WA, 98119, USA

    T. P. Do

  3. Wade Outcomes Research and Consulting, 136 U Street, Salt Lake City, UT, 84103, USA

    S. W. Wade

  4. Amgen Inc, One Amgen Center Drive, MS: 24-2-A, Thousand Oaks, CA, 91320, USA

    M. S. Anthony

  5. Virginia Commonwealth University School of Medicine, 1101 E Marshall Street, 7-015, P.O. Box 980111, Richmond, VA, 23298-0111, USA

    R. W. Downs

  6. HB 7505 Clinical Research, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH, 03756, USA

    A. N. A. Tosteson

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  1. A. N. A. Tosteson
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  2. T. P. Do
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  3. S. W. Wade
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  4. M. S. Anthony
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  5. R. W. Downs
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Correspondence to A. N. A. Tosteson.

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Tosteson, A.N.A., Do, T.P., Wade, S.W. et al. Persistence and switching patterns among women with varied osteoporosis medication histories: 12-month results from POSSIBLE US™. Osteoporos Int 21, 1769–1780 (2010). https://doi.org/10.1007/s00198-009-1133-5

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  • DOI: https://doi.org/10.1007/s00198-009-1133-5

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