Skip to main content
Top
Published in: Osteoporosis International 4/2017

01-04-2017 | Original Article

Frequency of discontinuation of injectable osteoporosis therapies in US patients over 2 years

Authors: A. Modi, S. Sajjan, R. Insinga, J. Weaver, E. M. Lewiecki, S. T. Harris

Published in: Osteoporosis International | Issue 4/2017

Login to get access

Abstract

Summary

Little is known about treatment patterns with injectable osteoporosis therapies. At 12 months, the probability of discontinuation was 69.1% among patients using ibandronate, followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment. The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation.

Introduction

This study was designed to assess the frequency of treatment discontinuation over time among patients who initiate injectable osteoporosis therapies.

Methods

This retrospective observational study utilized an administrative claims database to measure discontinuation of injectable osteoporosis therapy, reported at 6-month intervals over 2 years. Eligible patients were aged ≥55 years, had newly initiated injectable osteoporosis therapy between January 2008 and June 2012, and were continuously enrolled in the health plan for ≥1 year prior to and ≥1.5 years after the date the first injectable medication was received (the index date). Follow-up time ranged from 18 to 24 months. Injectable osteoporosis treatments included in the analysis were denosumab, ibandronate, teriparatide, and zoledronic acid. Discontinuation was assessed using Kaplan–Meier survival analysis and was defined at each time point as the percentage of patients who did not receive the dose scheduled for that time point. A 90-day grace period was allowed to accommodate flexibility in the scheduling of post-index re-administrations. Sensitivity analyses assessed discontinuation using grace periods of 60 and 30 days.

Results

A total of 4756 patients met the inclusion criteria for the study, with 617 utilizing denosumab, 233 ibandronate, 778 teriparatide, and 3128 zoledronic acid. At 12 months, discontinuation was highest among patients using ibandronate (69.1%), followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment: 87.5% for ibandronate, 87.9% for teriparatide, 79.8% for zoledronic acid, and 64.3% for denosumab.

Conclusions

The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation.
Literature
3.
go back to reference Karlsson L, Lundkvist J, Psachoulia E, Intorcia M, Strom O (2015) Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporos Int 26:2401–2411. doi:10.1007/s00198-015-3253-4 CrossRefPubMedPubMedCentral Karlsson L, Lundkvist J, Psachoulia E, Intorcia M, Strom O (2015) Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis. Osteoporos Int 26:2401–2411. doi:10.​1007/​s00198-015-3253-4 CrossRefPubMedPubMedCentral
4.
go back to reference Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022. doi:10.4065/81.8.1013 CrossRefPubMed Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022. doi:10.​4065/​81.​8.​1013 CrossRefPubMed
9.
10.
go back to reference Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55CrossRefPubMed Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55CrossRefPubMed
11.
go back to reference Ringe JD, Farahmand P (2014) Improved real-life adherence of 6-monthly denosumab injections due to positive feedback based on rapid 6-month BMD increase and good safety profile. Rheumatol Int 34:727–732. doi:10.1007/s00296-012-2663-2 CrossRefPubMed Ringe JD, Farahmand P (2014) Improved real-life adherence of 6-monthly denosumab injections due to positive feedback based on rapid 6-month BMD increase and good safety profile. Rheumatol Int 34:727–732. doi:10.​1007/​s00296-012-2663-2 CrossRefPubMed
12.
go back to reference Briot K, Ravaud P, Dargent-Molina P, Zylberman M, Liu-Leage S, Roux C (2009) Persistence with teriparatide in postmenopausal osteoporosis; impact of a patient education and follow-up program: the French experience. Osteoporos Int 20:625–630. doi:10.1007/s00198-008-0698-8 CrossRefPubMed Briot K, Ravaud P, Dargent-Molina P, Zylberman M, Liu-Leage S, Roux C (2009) Persistence with teriparatide in postmenopausal osteoporosis; impact of a patient education and follow-up program: the French experience. Osteoporos Int 20:625–630. doi:10.​1007/​s00198-008-0698-8 CrossRefPubMed
13.
go back to reference Hazel-Fernandez L, Louder AM, Foster SA, Uribe CL, Burge RT (2013) Association of teriparatide adherence and persistence with clinical and economic outcomes in Medicare part D recipients: a retrospective cohort study. BMC Musculoskelet Disord 14:4. doi:10.1186/1471-2474-14-4 CrossRefPubMedPubMedCentral Hazel-Fernandez L, Louder AM, Foster SA, Uribe CL, Burge RT (2013) Association of teriparatide adherence and persistence with clinical and economic outcomes in Medicare part D recipients: a retrospective cohort study. BMC Musculoskelet Disord 14:4. doi:10.​1186/​1471-2474-14-4 CrossRefPubMedPubMedCentral
16.
go back to reference Foster SA, Foley KA, Meadows ES, Johnston JA, Wang SS, Pohl GM, Long SR (2011) Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int 22:551–557. doi:10.1007/s00198-010-1297-z CrossRefPubMed Foster SA, Foley KA, Meadows ES, Johnston JA, Wang SS, Pohl GM, Long SR (2011) Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int 22:551–557. doi:10.​1007/​s00198-010-1297-z CrossRefPubMed
17.
go back to reference Kyvernitakis I, Kostev K, Kurth A, Albert US, Hadji P (2014) Differences in persistency with teriparatide in patients with osteoporosis according to gender and health care provider. Osteoporos Int 25:2721–2728. doi:10.1007/s00198-014-2810-6 CrossRefPubMed Kyvernitakis I, Kostev K, Kurth A, Albert US, Hadji P (2014) Differences in persistency with teriparatide in patients with osteoporosis according to gender and health care provider. Osteoporos Int 25:2721–2728. doi:10.​1007/​s00198-014-2810-6 CrossRefPubMed
19.
go back to reference Hadji P, Papaioannou N, Gielen E, Feudjo Tepie M, Zhang E, Frieling I, Geusens P, Makras P, Resch H, Moller G, Kalouche-Khalil L, Fahrleitner-Pammer A (2015) Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int 26:2479–2489. doi:10.1007/s00198-015-3164-4 CrossRefPubMedPubMedCentral Hadji P, Papaioannou N, Gielen E, Feudjo Tepie M, Zhang E, Frieling I, Geusens P, Makras P, Resch H, Moller G, Kalouche-Khalil L, Fahrleitner-Pammer A (2015) Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int 26:2479–2489. doi:10.​1007/​s00198-015-3164-4 CrossRefPubMedPubMedCentral
20.
go back to reference Curtis JR, Yun H, Matthews R, Saag KG, Delzell E (2012) Adherence with intravenous zoledronate and intravenous ibandronate in the United States Medicare population. Arthritis Care Res (Hoboken) 64:1054–1060. doi:10.1002/acr.21638 Curtis JR, Yun H, Matthews R, Saag KG, Delzell E (2012) Adherence with intravenous zoledronate and intravenous ibandronate in the United States Medicare population. Arthritis Care Res (Hoboken) 64:1054–1060. doi:10.​1002/​acr.​21638
21.
go back to reference Silverman SL, Siris E, Kendler DL, Belazi D, Brown JP, Gold DT, Lewiecki EM, Papaioannou A, Simonelli C, Ferreira I, Balasubramanian A, Dakin P, Ho P, Siddhanti S, Stolshek B, Recknor C (2015) Persistence at 12 months with denosumab in postmenopausal women with osteoporosis: interim results from a prospective observational study. Osteoporos Int 26:361–372. doi:10.1007/s00198-014-2871-6 CrossRefPubMed Silverman SL, Siris E, Kendler DL, Belazi D, Brown JP, Gold DT, Lewiecki EM, Papaioannou A, Simonelli C, Ferreira I, Balasubramanian A, Dakin P, Ho P, Siddhanti S, Stolshek B, Recknor C (2015) Persistence at 12 months with denosumab in postmenopausal women with osteoporosis: interim results from a prospective observational study. Osteoporos Int 26:361–372. doi:10.​1007/​s00198-014-2871-6 CrossRefPubMed
22.
go back to reference Cheng LI, Durden E, Limone B, Radbill L, Juneau PL, Spangler L, Mirza FM, Stolshek BS (2015) Persistance and compliance with osteroporosis therapies among women in a commercially insured population in the United States. J Manag Care Spec Pharm 21:824–833CrossRefPubMed Cheng LI, Durden E, Limone B, Radbill L, Juneau PL, Spangler L, Mirza FM, Stolshek BS (2015) Persistance and compliance with osteroporosis therapies among women in a commercially insured population in the United States. J Manag Care Spec Pharm 21:824–833CrossRefPubMed
23.
go back to reference Papaioannou A, Khan A, Belanger A, Bensen W, Kendler D, Theoret F, Amin M, Brekke L, Erdmann M, Walker V, Adachi JD (2015) Persistence with denosumab therapy among osteoporotic women in the Canadian patient-support program. Curr Med Res Opin 31:1391–1401. doi:10.1185/03007995.2015.1053049 CrossRefPubMed Papaioannou A, Khan A, Belanger A, Bensen W, Kendler D, Theoret F, Amin M, Brekke L, Erdmann M, Walker V, Adachi JD (2015) Persistence with denosumab therapy among osteoporotic women in the Canadian patient-support program. Curr Med Res Opin 31:1391–1401. doi:10.​1185/​03007995.​2015.​1053049 CrossRefPubMed
25.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
33.
39.
go back to reference 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 25:2251–2255. doi:10.1002/jbmr.103 CrossRefPubMed 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 25:2251–2255. doi:10.​1002/​jbmr.​103 CrossRefPubMed
40.
go back to reference US Food and Drug Administration (2002) Forteo [prescribing information]. US Food and Drug Administration (2002) Forteo [prescribing information].
Metadata
Title
Frequency of discontinuation of injectable osteoporosis therapies in US patients over 2 years
Authors
A. Modi
S. Sajjan
R. Insinga
J. Weaver
E. M. Lewiecki
S. T. Harris
Publication date
01-04-2017
Publisher
Springer London
Published in
Osteoporosis International / Issue 4/2017
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-016-3886-y

Other articles of this Issue 4/2017

Osteoporosis International 4/2017 Go to the issue