[口服双膦酸盐每日及每周给药用于骨质疏松症治疗的依从性]

[Adherence with daily and weekly administration of oral bisphosphonates for osteoporosis treatment].

作者信息

Bartl R, Götte S, Hadji P, Hammerschmidt T

机构信息

Bayerisches Osteoporosezentrum der Universität München, Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Grosshadern, München.

出版信息

Dtsch Med Wochenschr. 2006 Jun 2;131(22):1257-62. doi: 10.1055/s-2006-946559.

DOI:10.1055/s-2006-946559

PMID:16755420

Abstract

BACKGROUND AND OBJECTIVE

Bisphosphonates provide efficacious treatment for osteoporosis. However, side effects often lead to patients discontinuing this treatment. This study analyses differences in adherence (including acceptance, persistence and compliance) between daily (ALD-D) and weekly (ALD-W) administration of alendronate among German patients with osteoporosis.

METHODS

Prescription claims data of two random groups of subjects (144 patients each) taking ALD-D and ALD-W, respectively, were observed for 12 months after starting the given prescription. Termination was defined as the moment when the last prescription had been used up. The percentage of patients continuing the drug treatment after the first prescription was used as a measure for acceptance. Compliance was measured by the medication possession ratio (MPR), namely the percentage of days on which the patient was supplied with the medication. An MPR > 80% is therapeutically relevant because the risk of fractures is significantly reduced.

RESULTS

31.3% (ALD-W) vs. 45.8% (ALD-D) of patients discontinued therapy after one prescription. 53.5% (ALD-W) vs. 72.2% (ALD-D) of patients discontinued therapy throughout the year. The proportion of those who discontinued the treatment was significantly higher with daily administration (p=0.0035). Mean time until discontinuation was 220 days (ALD-W) vs. 169 days (ALD-D). Mean compliance among any patients was 51.7% (ALD-W) vs. 37.7% (ALD-D); Only 30.6% (ALD-W) vs. 19.2% (ALD-D) (p=0,0295) of patients reached a therapeutically relevant compliance level.

CONCLUSIONS

A large proportion of patients discontinued treatment with bisphosphonates, a majority of discontinuing patients not even refilling their first prescription. Adherence, although enhanced by less frequent dosing, was suboptimal in all of its aspects, i.e. acceptance, persistence and compliance. There is a need for treatment strategies to increase adherence.

摘要

背景与目的

双膦酸盐为骨质疏松症提供了有效的治疗方法。然而，副作用常常导致患者中断这种治疗。本研究分析了德国骨质疏松症患者中阿仑膦酸钠每日给药（ALD-D）和每周给药（ALD-W）在依从性（包括接受度、持续性和顺应性）方面的差异。

方法

分别观察两组随机选取的服用ALD-D和ALD-W的受试者（每组144例患者）在开始给定处方后的12个月内的处方申请数据。终止定义为最后一张处方用完的时刻。将首次处方后继续药物治疗的患者百分比用作接受度的衡量指标。顺应性通过药物持有率（MPR）来衡量，即患者获得药物供应的天数百分比。MPR>80%具有治疗相关性，因为骨折风险会显著降低。

结果

一张处方后停药的患者比例为31.3%（ALD-W）对45.8%（ALD-D）。全年停药的患者比例为53.5%（ALD-W）对72.2%（ALD-D）。每日给药时停药的比例显著更高（p = 0.0035）。直至停药的平均时间为220天（ALD-W）对169天（ALD-D）。所有患者的平均顺应性为51.7%（ALD-W）对37.7%（ALD-D）；达到治疗相关顺应性水平的患者仅为30.6%（ALD-W）对19.2%（ALD-D）（p = 0.0295）。