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. 2020 Nov;28(11):5223-5233.
doi: 10.1007/s00520-020-05357-5. Epub 2020 Feb 21.

Real-world use of denosumab and bisphosphonates in patients with solid tumours and bone metastases in Germany

Ingo Diel  1 , Sonja Ansorge  2 , David Hohmann  3 , Christina Giannopoulou  4 , Daniela Niepel  5 , Michele Intorcia  4
Affiliations

Real-world use of denosumab and bisphosphonates in patients with solid tumours and bone metastases in Germany

Ingo Diel et al. Support Care Cancer. 2020 Nov.

Abstract

Purpose: Bisphosphonates and denosumab prevent bone complications in patients with bone metastases from solid tumours. This retrospective, longitudinal, cohort study provides data on their real-world use in this setting in Germany.

Methods: Adults with bone metastases from breast, prostate or lung cancer who were newly initiated on a bisphosphonate or denosumab between 1 July 2011 and 31 December 2015 were identified from a German healthcare insurance claims database. Primary outcomes included persistence, compliance, discontinuation and switch rates at 12 months.

Results: This study included 1130 patients with bone metastases: 555 (49%) had breast cancer, 361 (32%) prostate cancer and 242 (21%) lung cancer. Mean age was 65 years for patients with breast or lung cancer and 74 years for those with prostate cancer. Across all tumour types, compared with any bisphosphonate, 12-month persistence was higher with denosumab (breast cancer 78% vs 54-58%, prostate cancer 58% vs 50%, lung cancer 68% vs 34-60%), median time to discontinuation was longer with denosumab and switch rates were lower for denosumab (breast cancer 5% vs 14-19%, prostate cancer 2% vs 11%, lung cancer 3% vs 7-12%). Compliance at 12 months was longer for denosumab than for any bisphosphonate in breast cancer (75% vs 42-48%) and in prostate cancer (47% vs 36%).

Conclusions: Patients initiated on denosumab following a diagnosis of bone metastases from breast, prostate or lung cancer had greater medication persistence, longer time to discontinuation, improved compliance and lower switch rates than those initiated on a bisphosphonate.

Keywords: Bisphosphonates; Bone metastases; Compliance; Denosumab; Discontinuation; Persistence.

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Conflict of interest statement

This study was conducted by Vilua Healthcare with funding provided by Amgen (Europe) GmbH. ID has received consulting and lecture honoraria from Amgen, and lecture honoraria from AstraZeneca, Riemser, Roche and TEVA. SA was an employee of Vilua Healthcare (formerly Arvato Health Analytics) GmbH at the time of the study, which received funding from Amgen GmbH. CG is an employee of Amgen. MI and DH were employees of Amgen at the time of the study. DN is an employee of Amgen and holds Amgen stocks.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of medication persistence, stratified by index date therapy and solid tumour type. Medication persistence was analysed for the index date therapy only. Data shown here were calculated using a 90-day gap period. Patients were censored at the end of data collection, loss to follow-up or death. BM, bone metastases
Fig. 2
Fig. 2
Time to initiation of denosumab or bisphosphonate therapy post bone metastases from solid tumour diagnosis, stratified by solid tumour type. Exploratory analysis of time to initiation of denosumab or bisphosphonate was analysed for all treatments combined. BM, bone metastases
Fig. 3
Fig. 3
Time to first and subsequent bone complications in patients with solid tumours, stratified by time to denosumab/bisphosphonate initiation (early [≤ 3 months]/late [> 3–9 months]). Exploratory analysis of time to first or subsequent bone complication was analysed for all treatments combined
See this image and copyright information in PMC

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