Compliance with oral bisphosphonates as low as 28%

  • BMJ Open

  • curated by Dawn O'Shea
  • International Clinical Digest
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Takeaway

  • Real-world persistence and adherence with oral bisphosphonates is suboptimal.
  • Determinants of persistence and adherence included geographic residence, history of fractures, race/ethnicity, income, marital status, medication type and dosing frequency.

Why this matters

  • Knowing patient determinants will help maximise persistence and adherence.

Study design

  • Systematic review of 89 observational (retrospective and prospective) studies, after search of MEDLINE, Allied and Comprehensive Medicine Database, Database of Abstracts of Reviews of Effects.
  • RCTs excluded.
  • Persistence is defined as the time between initiation and discontinuation.
  • Adherence (or medication possession ratio [MPR]) is the number of days' supply received divided by the length of the follow-up period.

Key results

  • Age of participants ranged from 53 to 80.8 years, with 3 months to 14 years follow-up.
  • Mean persistence of oral bisphosphonates ranged from 34.8% to 71.3% for 6 months, 17.7% to 74.8% for 1 year, and 12.9% to 72.0% for 2 years.
  • Mean adherence (MPR) ranged from 28.2% to 84.5% over 1 year, 23% to 50% over 2 years, and 27.2% to 46% over 3 years.
  • Determinants of persistence and adherence included geographic residence, prior bone mineral density test, history of fractures, race/ethnicity, income, marital status, medication type and dosing frequency.

Limitations

  • Meta-analysis not possible due to heterogeneity.

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