Curtis J R, Westfall A O, Allison J J, Freeman A, Saag K G
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 820, 510 20th Street South, 35294, USA.
Osteoporos Int. 2006;17(8):1268-74. doi: 10.1007/s00198-006-0136-8. Epub 2006 May 19.
Despite the efficacy of bisphosphonates to reduce fractures in high risk populations, bisphosphonate adherence among chronic glucocorticoid users has received limited attention. Moreover, perceived differences in GI tolerability may lead physicians to preferentially prescribe particular bisphosphonates.
Among chronic glucocorticoid users (>60 days of therapy) enrolled in managed care, we identified individuals initiating therapy with alendronate or risedronate during 2001-2004. Multivariable logistic regression and proportional hazards models were used to examine factors associated with channeling patients to risedronate (versus alendronate) and with discontinuation (>3-month gap without refill). The Medication Possession Ratio (MPR) was calculated as the filled days of medication divided by the interval of time between prescriptions.
Of 1,158 glucocorticoid users initiating bisphosphonate therapy, demographic characteristics of alendronate users (n=754) and risedronate users (n=404) were similar for age (mean 53 years) and gender (approximately 80% female). Past history of a GI symptom or event was associated with risedronate receipt (OR=2.24, 95% CI 1.15-4.35). After multivariable adjustment, rates of discontinuation (mean time to discontinuation approximately 18 months) and adherence (mean MPR=73%) were similar between users of the two bisphosphonates. Younger age, greater medical comorbidity, and lack of BMD testing were significantly associated with discontinuation.
Overall persistence rates were suboptimal for bisphosphonate use among chronic glucocorticoids users and did not differ significantly by drug. Newer strategies to promote long-term adherence are needed to improve osteoporosis therapeutic effectiveness.
尽管双膦酸盐在降低高危人群骨折风险方面疗效显著，但慢性糖皮质激素使用者对双膦酸盐的依从性却很少受到关注。此外，胃肠道耐受性方面的认知差异可能导致医生更倾向于开具特定的双膦酸盐药物。
在参加管理式医疗的慢性糖皮质激素使用者（治疗时间>60天）中，我们确定了2001年至2004年间开始使用阿仑膦酸钠或利塞膦酸钠治疗的个体。采用多变量逻辑回归和比例风险模型来研究促使患者选择利塞膦酸钠（而非阿仑膦酸钠）以及停药（超过3个月未再取药）的相关因素。药物持有率（MPR）的计算方法为已配药天数除以两次处方之间的时间间隔。
在1158名开始双膦酸盐治疗的糖皮质激素使用者中，阿仑膦酸钠使用者（n = 754）和利塞膦酸钠使用者（n = 404）在年龄（平均53岁）和性别（约80%为女性）方面的人口统计学特征相似。既往有胃肠道症状或事件史与使用利塞膦酸钠有关（比值比=2.24，95%可信区间1.15 - 4.35）。经过多变量调整后，两种双膦酸盐使用者的停药率（平均停药时间约18个月）和依从率（平均MPR = 73%）相似。年龄较小、合并症较多以及未进行骨密度检测与停药显著相关。
慢性糖皮质激素使用者中双膦酸盐的总体持续使用率不理想，且不同药物之间无显著差异。需要新的策略来促进长期依从性，以提高骨质疏松症的治疗效果。
