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. 2023 Oct;34(10):1771-1781.
doi: 10.1007/s00198-023-06837-0. Epub 2023 Jul 12.

Drug utilization analysis of osteoporosis medications in seven European electronic health databases

Eng Hooi Tan  1 , Danielle E Robinson  1 , Annika M Jödicke  1 , Mees Mosseveld  2 , Katrine Bødkergaard  3 , Carlen Reyes  4 , Alireza Moayyeri  5 , Annemarie Voss  6 , Ettore Marconi  7 , Francesco Lapi  7 , Jonas Reinold  6 , Katia M C Verhamme  2 , Lars Pedersen  3 , Malte Braitmaier  8 , Marcel de Wilde  2 , Marc Far Ruiz  4 , María Aragón  4 , Pauline Bosco-Levy  9 , Regis Lassalle  9 , Daniel Prieto-Alhambra  10   11 , Maria T Sanchez-Santos  1
Affiliations

Drug utilization analysis of osteoporosis medications in seven European electronic health databases

Eng Hooi Tan et al. Osteoporos Int. 2023 Oct.

Abstract

We studied the characteristics of patients prescribed osteoporosis medication and patterns of use in European databases. Patients were mostly female, older, had hypertension. There was suboptimal persistence particularly for oral medications. Our findings would be useful to healthcare providers to focus their resources on improving persistence to specific osteoporosis treatments.

Purpose: To characterise the patients prescribed osteoporosis therapy and describe the drug utilization patterns.

Methods: We investigated the treatment patterns of bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators (SERMs) in seven European databases in the United Kingdom, Italy, the Netherlands, Denmark, Spain, and Germany. In this cohort study, we included adults aged ≥ 18 years, with ≥ 1 year of registration in the respective databases, who were new users of the osteoporosis medications. The study period was between 01 January 2018 to 31 January 2022.

Results: Overall, patients were most commonly initiated on alendronate. Persistence decreased over time across all medications and databases, ranging from 52-73% at 6 months to 29-53% at 12 months for alendronate. For other oral bisphosphonates, the proportion of persistent users was 50-66% at 6 months and decreased to 30-44% at 12 months. For SERMs, the proportion of persistent users at 6 months was 40-73% and decreased to 25-59% at 12 months. For parenteral treatment groups, the proportions of persistence with denosumab were 50-85% (6 month), 30-63% (12 month) and with teriparatide 40-75% (6 month) decreasing to 21-54% (12 month). Switching occurred most frequently in the alendronate group (2.8-5.8%) and in the teriparatide group (7.1-14%). Switching typically occurred in the first 6 months and decreased over time. Patients in the alendronate group most often switched to other oral or intravenous bisphosphonates and denosumab.

Conclusion: Our results show suboptimal persistence to medications that varied across different databases and treatment switching was relatively rare.

Keywords: Anabolic drug; Anti-resorptive drug; Osteoporosis; Persistence; Switching.

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Conflict of interest statement

AM is employed by UCB Biopharma SRL. AV, JR, and MB are working at an independent, non-profit research institute, the Leibniz Institute for Prevention Research and Epidemiology – BIPS. EM and FP provided consultancies in protocol preparation for epidemiological studies and data analyses for Amgen. PBL and RL are working at an independent, non-profit research institute, the Bordeaux PharmacoEpi platform (BPE) at Bordeaux University. KV, MM, Marcel de Wilde (MW) report receiving institutional funding support from the European Medicines Agency and Innovative Medicines Initiative. KV, MM, MW have received institutional grants from Johnson and Johnson, UCB, Chiesi, GSK, and Amgen outside this work. DPA’s department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. His research group has received consultancy fees from Astra Zeneca and UCB Biopharma. Amgen, Astellas, Janssen, Synapse Management Partners and UCB Biopharma have funded or supported training programmes organised by DPA's department. EHT, DR, AJ, MSS, KB, CR, LP, MFR, MA have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
A Sankey diagram of treatment switching pattern (CPRD GOLD). B Sankey diagram of treatment switching pattern (CPRD AURUM). C Sankey diagram of treatment switching pattern (HSD). D Sankey diagram of treatment switching pattern (IPCI). E Sankey diagram of treatment switching pattern (NDR). F Sankey diagram of treatment switching pattern (SIDIAP). G Sankey diagram of treatment switching pattern (GePaRD). ALN: alendronate; DENO: denosumab; IVBP: intravenous bisphosphonates; OBP: other oral bisphosphonates; SERM: selective estrogen receptor modulators; TERI: teriparatide. The colour coded paths depict the proportion of users continuing/switching treatment at time points 6 months, 12 months, 18 months, and 24 months. The red paths depict the proportion of users who discontinued treatment (STOP). The grey paths depict the proportion of users censored (CEN) (end of follow-up) before the respective time points
See this image and copyright information in PMC

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