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Single pharmacy governed denosumab home administration: optimal adherence by means of a fracture liaison service (FLS) and home care collaboration

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Abstract

Summary

Low adherence for denosumab (Dmab, Prolia®) is of major concern. Dutch pharmacies deliveries were calculated recently being 76.5% for a total of 3 injections.

Introduction

Comparing a model where the prescriber maintains responsibility for adherence (model HC1) (Dmab is purchased and dispensed by patient’s own community pharmacy and administered through a home care service (HC)) or an all-in-one model where the pharmacist maintains responsibility for the adherence (Dmab is purchased, dispensed, and administered by a pharmacist’s HC) (HC2).

Methods

We counted the number of Dmab injections, follow-up appointments on time, Dmab administrations delayed to a maximum of 60 days, the number of Dmab discontinuations, and all causes legally traceable under EU privacy act (EDPR).

Results

Home care started by 2014 (study closure in 2021) and included 711 Dmab injections to 256 unique patients: HC1: 536 and HC2: 175 orders. The whole group received on average 2.8 Dmab injections by consistent intervals of about 182 days. Average administration after the latest Dmab injection: 272.8 days (HC1: 362.0 and HC2: 124.0 days). Administration of a subsequent injection > 60 days occurred in 26.6% (HC1: 38.8% and HC2: 6.2%; OR = 9.49). After adjustment for no more than three Dmab injections administered per patient, it occurred in 27.3% (HC1: 51.8% and HC2 4.4%; OR = 23.34).

Conclusion

It was possible to achieve 94% adherence for Dmab injections treatment just by transferring the complete supply chain to one pharmacy-initiated home care provider after treatment initiation by either a physician or FLS health care professional.

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References

  1. Jansà M, Hernández C, Vidal M, Nuñez M, Bertran MJ, Sanz S et al (2010) Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital. Patient Educ Couns [Internet]. [cited 2021 Apr 24];81(2):161–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20167450/

  2. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A et al (2014) Interventions for enhancing medication adherence [Internet]. Vol. 2014, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; [cited 2021 Apr 17]. Available from: https://pubmed.ncbi.nlm.nih.gov/25412402/

  3. Abrahamsen B (2013) Are long-term bisphosphonate users a reality? Dose years for current bisphosphonate users assessed using the danish national prescription database. Osteoporos Int [Internet]. [cited 2021 Apr 17];24(1):369–72. Available from: https://pubmed.ncbi.nlm.nih.gov/22572963/

  4. Hansen C, Pedersen BD, Konradsen H, Abrahamsen B (2013) Anti-osteoporotic therapy in Denmark—predictors and demographics of poor refill compliance and poor persistence. Osteoporos Int [Internet]. [cited 2021 Apr 17];24(7):2079–97. Available from: https://pubmed.ncbi.nlm.nih.gov/23179576/

  5. Netelenbos JC, Geusens PP, Ypma G, Buijs SJE (2011) Adherence and profile of non-persistence in patients treated for osteoporosis-a large-scale, long-term retrospective study in the Netherlands. Osteoporos Int [Internet]. [cited 2021 Apr 17];22(5):1537–46. Available from: https://pubmed.ncbi.nlm.nih.gov/20838773/

  6. Hadji P, Kyvernitakis I, Kann PH, Niedhart C, Hofbauer LC, Schwarz H et al (2016) GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab. Osteoporos Int [Internet]. [cited 2021 Apr 25];27(10):2967–78. Available from: https://pubmed.ncbi.nlm.nih.gov/27172934/

  7. Koller G, Goetz V, Vandermeer B, Homik J, McAlister FA, Kendler D et al (2020) Persistence and adherence to parenteral osteoporosis therapies: a systematic review [Internet]. Vol. 31, Osteoporosis International. Springer Science and Business Media Deutschland GmbH; [cited 2021 Apr 17]. p. 2093–102. Available from: https://pubmed.ncbi.nlm.nih.gov/32613409/

  8. Tsuda T, Hashimoto Y, Okamoto Y, Ando W, Ebina K (2020) Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention. J Bone Miner Metab [Internet]. [cited 2021 Apr 17];38(5):678–86. Available from: https://pubmed.ncbi.nlm.nih.gov/32236684/

  9. Aubry-Rozier B, Gonzalez-Rodriguez E, Stoll D, Lamy O (2016) Severe spontaneous vertebral fractures after denosumab discontinuation: three case reports. Osteoporos Int [Internet]. [cited 2021 Apr 24];27(5):1923–5. Available from: https://pubmed.ncbi.nlm.nih.gov/26510845/

  10. Anastasilakis AD, Makras P (2016) Multiple clinical vertebral fractures following denosumab discontinuation, vol 27. Osteoporosis International. Springer, London, pp 1929–1930

    Google Scholar 

  11. Popp AW, Zysset PK, Lippuner K (2016) Rebound-associated vertebral fractures after discontinuation of denosumab—from clinic and biomechanics. Osteoporos Int 27(5):1917–1921

    Article  CAS  Google Scholar 

  12. Anastasilakis AD, Polyzos SA, Makras P, Aubry-Rozier B, Kaouri S, Lamy O (2017) Clinical features of 24 patients with rebound-associated vertebral fractures after denosumab discontinuation: systematic review and additional cases. J Bone Miner Res 32(6):1291–1296

    Article  CAS  Google Scholar 

  13. McClung MR, Wagman RB, Miller PD, Wang A, Lewiecki EM (2017) Observations following discontinuation of long-term denosumab therapy. Osteoporos Int 28(5):1723–1732

    Article  CAS  Google Scholar 

  14. Tsourdi E, Langdahl B, Cohen-Solal M, Aubry-Rozier B, Eriksen EF, Guañabens N et al (2017) Discontinuation of denosumab therapy for osteoporosis: a systematic review and position statement by ECTS [Internet]. Vol. 105, Bone. Elsevier Inc.; [cited 2021 Apr 18]. p. 11–7. Available from: https://pubmed.ncbi.nlm.nih.gov/28789921/

  15. Tsourdi E, Zillikens MC, Meier C, Body JJ, Gonzalez Rodriguez E, Anastasilakis AD et al (2021) Fracture risk and management of discontinuation of denosumab therapy: a systematic review and position statement by ECTS. J Clin Endocrinol Metab [Internet]. [cited 2021 Apr 17];106(1):264–81. Available from: https://pubmed.ncbi.nlm.nih.gov/33103722/

  16. Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures [Internet]. Vol. 163, Cmaj. [cited 2021 Apr 25]. p. 819–22. Available from: https://pubmed.ncbi.nlm.nih.gov/11033708/

  17. van den Berg P, Schweitzer DH, van Haard PMM, van den Bergh JP, Geusens PP (2015) Meeting international standards of secondary fracture prevention: a survey on fracture liaison services in the Netherlands. Osteoporos Int [Internet]. [cited 2018 Jul 6];26(9):2257–63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25860976

  18. Vik SA, Maxwell CJ, Hanley DA (2005) Treatment of osteoporosis in an older home care population [Internet]. Vol. 6, BMC Musculoskeletal Disorders. BMC Musculoskelet Disord; [cited 2021 Apr 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/15707496/

  19. Zinnige Zorg - Verbetersignalement Osteoporose | Rapport | Zorginstituut Nederland [Internet]. [cited 2021 Apr 22]. Available from: https://www.zorginstituutnederland.nl/publicaties/rapport/2020/08/11/zinnige-zorg-verbetersignalement-osteoporose

  20. CBO Richtlijn Osteoporose en Fractuurpreventie-2011 | Volksgezondheidenzorg.info [Internet]. [cited 2021 Apr 22]. Available from: https://www.volksgezondheidenzorg.info/bestanden/documenten/cbo-richtlijn-osteoporose-en-fractuurpreventie-2011

  21. van den Berg P, van Haard PMM, van der Veer E, Geusens PP, van den Bergh JP, Schweitzer DH (2018) A dedicated Fracture Liaison Service telephone program and use of bone turnover markers for evaluating 1-year persistence with oral bisphosphonates. Osteoporos Int 29(4):813–824. https://doi.org/10.1007/s00198-017-4340-5

  22. Lyu H, Yoshida K, Zhao SS, Wei J, Zeng C, Tedeschi SK et al (2020) Delayed denosumab injections and fracture risk among patients with osteoporosis : a population-based cohort study. Ann Intern Med [Internet]. [cited 2021 May 26];173(7):516–26. Available from: https://pubmed.ncbi.nlm.nih.gov/32716706/

  23. Boonen S, Ferrari S, Miller PD, Eriksen EF, Sambrook PN, Compston J et al (2012) Postmenopausal osteoporosis treatment with antiresorptives: effects of discontinuation or long-term continuation on bone turnover and fracture risk—a perspective. J Bone Miner Res 27:963–74

    Article  CAS  Google Scholar 

  24. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the fracture intervention trial long-term extension (FLEX): a randomized trial. J Am Med Assoc [Internet]. [cited 2021 Apr 27];296(24):2927–38. Available from: https://pubmed.ncbi.nlm.nih.gov/17190893/

  25. Watts NB, Chines A, Olszynski WP, McKeever CD, McClung MR, Zhou X et al (2008) Fracture risk remains reduced one year after discontinuation of risedronate. Osteoporos Int [Internet]. [cited 2021 Apr 27];19(3):365–72. Available from: https://pubmed.ncbi.nlm.nih.gov/17938986/

  26. Grey A, Bolland MJ, Wattie D, Horne A, Gamble G, Reid IR (2009) The antiresorptive effects of a single dose of zoledronate persist for two years: a randomized, placebo-controlled trial in osteopenic postmenopausal women. J Clin Endocrinol Metab [Internet]. [cited 2021 Apr 27];94(2):538–44. Available from: https://pubmed.ncbi.nlm.nih.gov/19050050/

  27. Grey A, Bolland M, Wattie D, Horne A, Gamble G, Reid IR (2010) Prolonged antiresorptive activity of zoledronate: a randomized, controlled trial. J Bone Miner Res 25(10):2251–2255

    Article  CAS  Google Scholar 

  28. Black DM, Reid IR, Cauley JA, Cosman F, Leung PC, Lakatos P et al (2015) The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-pivotal fracture trial (PFT). J Bone Miner Res [Internet]. [cited 2021 Apr 27];30(5):934–44. Available from: https://pubmed.ncbi.nlm.nih.gov/25545380/

  29. Bone HG, Bolognese MA, Yuen CK, Kendler DL, Miller PD, Yang YC et al (2011) Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab [Internet]. Apr [cited 2021 Apr 27];96(4):972–80. Available from: https://pubmed.ncbi.nlm.nih.gov/21289258/

  30. Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JEB, McClung M et al (2018) Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res [Internet]. [cited 2021 Apr 28];33(2):190–8. Available from: https://pubmed.ncbi.nlm.nih.gov/29105841/

  31. Tripto-Shkolnik L, Fund N, Rouach V, Chodick G, Shalev V, Goldshtein I (2020) Fracture incidence after denosumab discontinuation: Real-world data from a large healthcare provider. Bone 130:115150. https://doi.org/10.1016/j.bone.2019.115150

  32. Walsh ME, Fahey T, Moriarty F (2021) Persistence with oral bisphosphonates and denosumab among older adults in primary care in Ireland. Arch Osteoporos [Internet]. [cited 2021 May 25];16(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33864529/

  33. Popp AW, Varathan N, Buffat H, Senn C, Perrelet R, Lippuner K (2018) Bone mineral density changes after 1 year of denosumab discontinuation in postmenopausal women with long-term denosumab treatment for osteoporosis. Calcif Tissue Int [Internet]. [cited 2021 Jun 26];103(1):50–4. Available from: https://pubmed.ncbi.nlm.nih.gov/29380013/

  34. Home | Capture the Fracture [Internet]. [cited 2021 May 2]. Available from: https://www.capturethefracture.org/

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Acknowledgements

We are most grateful to Mrs. Chantal Nielen MSc on behalf of Amgen, The Netherlands, for providing us Dutch denosumab delivery data free of any charge.

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Authors and Affiliations

  1. Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, The Netherlands

    P. van den Berg

  2. Zuid-Hollandse Apotheek Service (ZHAS), The Hague, The Netherlands

    E. Sluiter & M. H. Oosterveld

  3. Bare Statistics, Stompetoren, The Netherlands

    M. van Leerdam

  4. Department of Hospital Pharmacy, Reinier de Graaf Gasthuis, Delft, The Netherlands

    P. Langendijk

  5. Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, The Netherlands

    D. H. Schweitzer

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  1. P. van den Berg
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Correspondence to P. van den Berg.

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van den Berg, P., Sluiter, E., Oosterveld, M.H. et al. Single pharmacy governed denosumab home administration: optimal adherence by means of a fracture liaison service (FLS) and home care collaboration. Osteoporos Int 33, 881–887 (2022). https://doi.org/10.1007/s00198-021-06234-5

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