Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States

Abstract

This retrospective, observational study assessed 2-year persistence and compliance by treatment, route of administration, and dosing frequency in postmenopausal women initiating a new osteoporosis therapy. Two-year persistence and compliance rates were higher in women receiving injectables compared with oral agents.

Purpose: This study extends previous studies limited to 1-year follow-up by examining persistence with osteoporosis therapies over a 2-year period and compares short- and long-term trends in persistence and compliance among postmenopausal women with commercial or Medicare supplemental insurance in the USA.

Methods: This retrospective, observational cohort study enrolled women ≥50 years newly initiating osteoporosis therapy between January 1 and December 31, 2012 (i.e., the index date), with continuous enrollment ≥14 months before and ≥24 months after their index date. Persistence (continuous therapy without a >60-day gap) and compliance with the index therapy were evaluated at 2 years of follow-up. Multivariable logistic regression was used to compare the odds of persistence and compliance across treatment and dosing regimens.

Results: This study included 43,543 patients with mean (standard deviation) age 65 (10) years. At 2 years of follow-up, persistence and compliance were higher for patients treated with injectable agents (ranging from 34 to 41%, excluding an every-3-month injection) than those treated with oral agents (ranging from 20 to 31%). Additionally, patients initiating oral bisphosphonates (except risedronate once daily), raloxifene (daily), or zoledronic acid (annually) had significantly lower odds of persistence compared with denosumab (every 6 months).

Conclusions: Patients initiating injectable therapies had greater persistence and compliance at 2 years than those initiating oral therapies. Patients initiating an every-6-month injection had significantly higher persistence compared with those initiating more frequently dosed (e.g., daily and weekly) oral or injectable agents.

Keywords: Bisphosphonates; Compliance; Osteoporosis; Persistence.

Fig. 1

Patient selection. ^aDenosumab SC Q6M, alendronate QD oral, alendronate QW oral, ibandronate QM oral, ibandronate IV Q3M, risedronate QD oral, risedronate QW oral, risedronate QM oral, raloxifene, teriparatide SC QD, and zoledronic acid IV annual. HIV human immunodeficiency virus, IV intravenous, QD once daily, QM once monthly, Q3M once every 3 months, Q6M once every 6 months, QW once a week, SC subcutaneous

Fig. 2

Rates of persistence and compliance with osteoporosis therapies during 12- and 24-month follow-up. Rates of persistence (white bars) and compliance (black bars) among women receiving osteoporosis therapies of interest during a 12-month and b 24-month follow-up. IV intravenous, QD once daily, QM once monthly, Q3M once every 3 months, Q6M once every 6 months, QW once a week, SC subcutaneous