Adherence and persistence with osteoporosis medications – 3 studies
There are three articles published in June dealing with how well people adhere to (the ratio of medication prescribed to the medication remaining after the study period) or persist (continuous therapy on the same drug throughout the study period) with their osteoporosis therapy. The results aren't good, with anything over 50% of the people actually taking their prescribed medications being a good result. The following are the three studies with a brief explanation of exactly what was evaluated in the studies.
Dtsch Med Wochenschr. 2006 June;131(22):1257-1262, Bartl R and others. Adherence with daily and weekly administration of oral bisphosphonates for osteoporosis treatment. PMID: 16755420. This German study compared adherence between daily and weekly alendronate (Fosamax) in groups of 144 patients each during a 12-month period. The authors note that fractures are significantly reduced in individuals who take 80% of their medications. Results showed that 31.3 % and 45.8% of the weekly and daily medication groups, respectively, discontinued therapy after one prescription. And 53.5% (weekly) vs. 72.2% (daily) of the patients discontinued therapy throughout the year. Discontinuance was significantly worse among the daily group than the weekly one. Only 30.6% of the weekly group and 19.2% of the daily group reached therapeutically relevant compliance levels (that point where the medication would be expected to reduce fractures). The authors note: “There is a need for treatment strategies to increase adherence.”
Int J Clin Pract. 2006 Jun 23; [Epub ahead of print], Cooper A, Drake J, Brankin E. Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. PMID: 16800837. This six-month study compared persistence on treatment for women taking once-monthly ibandronate (Boniva) plus a patient support program (PSP), or once-weekly alendronate. Results showed 56.6% and 38.6% persistence in the ibandronate/PSP and alendronate groups, respectively.
South Med J. 2006 Jun;99(6):570-5, Downey TW and others. Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. PMID: 16800411. This twelve-month study in women in a managed care setting evaluated adherence/persistence rates for women taking alendronate (61%/21%), risedronate (58%/19%) and raloxifene (54%/16%).
Editor's comments: If 80% compliance is required to get significantly improved fracture reduction with osteoporosis medications, few in these studies reached that significant level. This appears to be a difficult challenge for health care providers. If only the patient was harmed by not taking their medication, there wouldn't be a problem. However, if taxpayers are paying for Medicare therapy and members of managed care programs are paying for group health care, then noncompliance affects the entire group, not just the patient. This issue looks like one where those paying for the treatment are overpaying doubly under the current situation: 1) If patients don't take their medications properly, payment goes out to cover the cost of medications that don't provide benefit, and 2) Patients who don't comply with taking medications at least 80% of the time, will suffer fractures that the payers then have to cover too. If care providers can find some method to entice patients to take their medications, that would resolve the issue. The same would result if payers revolt and refuse to pay for medications and treatments that patients don't deserve because they don't follow instructions. Somehow I don't see that ever happening, so methods need to be developed that will make patients want to take their medications to avoid the harmful consequences of not doing so. I know that I wear my seatbelt at all times because I saw a very impressive video that shows exactly and graphically what happens in an accident if you don't have your seat belt on. Perhaps osteoporosis patients could be shown a similarly graphic video of preoperative interviews with patients and surgical procedures that were required to repair the damage of osteoporosis that wasn't treated. In people whose disease is asymptomatic, that may be the only way to get their attention and make them want to comply.