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Comparative Study
. 2010 Mar;123(3):275-80.
doi: 10.1016/j.amjmed.2009.05.017.

Adoption of once-monthly oral bisphosphonates and the impact on adherence

Becky A Briesacher  1 , Susan E Andrade, Leslie R Harrold, Hassan Fouayzi, Robert A Yood
Affiliations
Comparative Study

Adoption of once-monthly oral bisphosphonates and the impact on adherence

Becky A Briesacher et al. Am J Med. 2010 Mar.

Abstract

Background: The extent of the adoption of once-monthly bisphosphonates into general clinical practice is not known, nor is it known if the novel formulation improves adherence.

Methods: We analyzed administrative claims 2003-2006 from a large employer-based health insurance database for incident use of oral bisphosphonates and stratified users by daily, weekly, and monthly dosing regimen. We measured adherence as the medication possession ratio (MPR) during the first year of therapy. We compared patient characteristics by dosing regimen and evaluated how the dosing regimen influenced the MPR.

Results: We identified 61,125 incident users of bisphosphonates (n=1034 daily, n=56,925 weekly, n=3166 monthly). Monthly bisphosphonate users were, on average, slightly older than the other groups (mean age 66 years for monthly users vs 65 years for weekly users or 66 years for daily users, P<.05) and more often lived in the North Central or South United States (76% vs 72% weekly users or 69% daily users, P<.05). There were no detectable differences among the dosing groups in the history of serious gastrointestinal risk, comorbidity burden, or prior osteoporotic fractures. During the first year of bisphosphonate therapy, 49% of monthly users had MPR> or =80% compared with 49% of weekly users (not significant) or 23% of daily users (P<.0001).

Conclusion: We found little evidence of preferential prescribing of monthly bisphosphonates to certain types of patients. Furthermore, we found no evidence of improved bisphosphonate adherence with monthly dosing relative to weekly dosing, although adherence with either weekly or monthly dosing was significantly better than with daily dosing.

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Figures

Figure 1
Figure 1. Adoption of Once Monthly Bisphosphonates by New Users
The percentage of new users on daily, weekly and monthly bisphosphonates 1 year before and 1 year after the approval of once-monthly bisphosphonates.
Figure 2
Figure 2. Overall Year 1 Adherence of Bisphosphonate Initiators by Dosing Frequency
The frequency distribution of the medication possession ratio for new users of daily, weekly and monthly bisphosphonates.
Figures 3a and 3b
Figures 3a and 3b
Stratified Year 1 Adherence of Bisphosphonate Initiators by Dosing Frequency and Key Baseline Characteristics. The mean medication possession ratio for new users of daily, weekly and monthly bisphosphonates stratified by gender, sex, health plan, geographic residence, bone mineral density testing, gastrointestinal disorder risk, hospitalization, and comorbidity risk. Footnote: D=daily dosing users, W=weekly dosing users, M=monthly dosing users
Figures 3a and 3b
Figures 3a and 3b
Stratified Year 1 Adherence of Bisphosphonate Initiators by Dosing Frequency and Key Baseline Characteristics. The mean medication possession ratio for new users of daily, weekly and monthly bisphosphonates stratified by gender, sex, health plan, geographic residence, bone mineral density testing, gastrointestinal disorder risk, hospitalization, and comorbidity risk. Footnote: D=daily dosing users, W=weekly dosing users, M=monthly dosing users
See this image and copyright information in PMC

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