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

Abstract

Summary 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. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-023-06837-0.

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: a cohort study

“… 24 Sixty-six percent of respondents reported that adjuvant intravenous bisphosphonate use had been impacted by the pandemic in terms of delayed treatment, missed appointments and reduced clinical capacity, requiring a switch from intravenous to oral administration, while nearly a quarter of respondents reported decreased use of oral bisphosphonates. This is in line with our results, which show that bisphosphonate prescriptions were indeed reduced across the pandemic for breast cancer patients on AIs (though it should be noted that this pattern is seen in other populations, not limited to cancer patients 25 ).…”

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

“…Sixty-six percent of respondents reported that adjuvant intravenous bisphosphonate use had been impacted by the pandemic, in terms of delayed treatment, missed appointments, and reduced clinical capacity, requiring a switch from intravenous to oral administra on; whilst nearly a quarter of respondents reported decreased use of oral bisphosphonates. This is in line with our results which show that prescrip ons of bisphosphonates were indeed reduced across the pandemic for breast cancer pa ents on AIs (though it should be noted that this pa ern is seen in other popula ons, not limited to cancer pa ents [24]).…”