Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink

Abstract

Gaining full benefits from osteoporosis medications requires long-term treatment. Investigating the real-world persistence of women receiving osteoporosis medications in the UK, we found that most patients stop treatment within a year. To prevent osteoporotic fragility fractures, long-term treatment persistence must be improved.

Introduction: Persistence with osteoporosis therapies has historically been poor. To treat this chronic and progressive disease, it is essential that patients receive the full benefit of these medications. We estimated persistence and compliance with osteoporosis therapies in a large sample of postmenopausal women in the UK.

Methods: Data were obtained from the Clinical Practice Research Datalink for all women aged 50 years and over or women with early menopause, who received at least one prescription in primary care for any licensed osteoporosis therapy between January 1, 2010 and December 31, 2015. Persistence and compliance at 24 months (primary objective) and at 5 years (exploratory objective) were estimated in three patient cohorts: "All Patients," "Naïve Patients," and "Drug-Specific."

Results: The All Patients cohort included 72,256 women. Persistence with any therapy was 56.1%, 43.6%, 36.4%, and 31.0% at 6, 12, 18, and 24 months, respectively, and 23.2% and 13.1% at 3 years and 5 years, respectively. Patients were generally more persistent and compliant if evaluated from their first exposure to osteoporosis therapy (Naïve Patients cohort). In the drug-specific analysis, 64% of patients receiving denosumab (administered subcutaneously every 6 months) were persistent at 24 months compared with 28% and 23% of those taking oral bisphosphonates and intravenous bisphosphonates, respectively.

Conclusions: Only about one in three patients who received osteoporosis therapy continued to be on treatment after 2 years. There is a need to improve persistence with osteoporosis therapy, especially for high-risk patients.

Keywords: CPRD; Clinical Practice Research Datalink; Compliance; Osteoporosis; Persistence; Postmenopausal.

Fig. 1

Flow charts for creation of the a) “‘All Patients’,” “‘Naïve Patients,”’ and b) “‘Drug-specific’ Specific” cohorts.a CPRD Clinical Practice Research Datalink, OP osteoporosis. a Patients could receive multiple drug classes during the observation period. Each patient could therefore have several non-treatment-naïve windows but only one treatment-naïve windowTables and figures

Fig. 2

Kaplan–Meier analysis of discontinuation with any class of osteoporosis medication in the “All Patients” and “Naïve Patients” cohorts using a 30-day permissible gap

Fig. 3

Kaplan–Meier analysis of discontinuation with each medication class over a 5-year period in the “‘Drug-specific’ Specific” cohort, using a 30-day permissible gap. Patients could contribute multiple records. The numbers at risk for each medication represent the number of records not the number of patients. PTH parathyroid hormone, SERM selective estrogen receptor modulators

Fig. 4

Kaplan–Meier analysis of discontinuation with each medication class over a 5-year period in the “‘Drug-specific”’ cohort (naïve vs non-naïve treatments), using a 30-day permissible gap. PTH parathyroid hormone, SERM selective estrogen receptor modulators