TRICARE Management Activity (TMA), Pharmacoeconomic Center, 4130 Stanley Road, Bldg 1000, Fort Sam Houston, San Antonio, TX 78234, USA.
Osteoporos Int. 2012 Apr;23(4):1415-24. doi: 10.1007/s00198-011-1729-4. Epub 2011 Jul 23.
This study evaluated whether patients treated with bisphosphonates in the US Military Health System were more compliant with treatment given monthly versus weekly. While medication compliance did improve with treatment given monthly, overall compliance with bisphosphonates was still suboptimal suggesting the need for further strategies to improve compliance with treatment for osteoporosis.
The study objective was to evaluate the relationship between bisphosphonate dosing interval and medication compliance among new users initiating oral bisphosphonates.
We conducted a retrospective observational cohort study of administrative claims data in the US Military Health System to examine medication compliance among 22,363 new users of oral bisphosphonates starting weekly (68%) or monthly (32%) therapy. Medication compliance during the first year of treatment was measured using two methods: (1) medication possession ratio (MPR) with compliance defined as ≥80% of days covered and (2) time to first gap of more than 30 days following initiation. Logistic regression and a proportional hazards model were used to detect differences in medication compliance between cohorts.
After the first year of therapy, 57% of subjects were not compliant with bisphosphonates (MPR <80%), while 84% experienced a gap in treatment of more than 30 days. After adjustment for study covariates, the odds of a patient being compliant with treatment was 21% higher among monthly users compared to weekly users (OR 1.207, 95% confidence interval (CI) 1.119-1.257). Similarly, the risk of experiencing a 30-day gap in treatment was 6% lower among monthly users compared to weekly users (HR 0.934, 95% CI 0.905-0.964).
Patients receiving oral bisphosphonates on a monthly basis showed higher rates of medication compliance compared to weekly dosing in our study. However, compliance with bisphosphonates among all new users was suboptimal, suggesting the need for improved strategies to enhance compliance with oral bisphosphonates in the US Military Health System.
本研究评估了在美国军事医疗系统中接受双磷酸盐治疗的患者每月接受治疗与每周接受治疗相比，其治疗的依从性是否更高。虽然每月接受治疗可提高药物依从性，但双磷酸盐治疗的总体依从性仍不理想，这表明需要进一步制定策略来提高对骨质疏松症治疗的依从性。
本研究的目的是评估新开始使用口服双膦酸盐的患者中双膦酸盐给药间隔与药物依从性之间的关系。
我们在美国军事医疗系统的行政索赔数据中进行了一项回顾性观察队列研究，以检查开始每周（68%）或每月（32%）治疗的 22363 名新口服双膦酸盐使用者的药物依从性。第一年治疗期间的药物依从性使用两种方法进行测量：（1）药物持有率（MPR），定义为≥80%的天数覆盖，以及（2）在开始后超过 30 天的第一次缺口时间。使用逻辑回归和比例风险模型来检测队列之间药物依从性的差异。
在治疗的第一年之后，57%的受试者不符合双磷酸盐治疗（MPR<80%），而 84%的受试者经历了超过 30 天的治疗中断。在调整研究协变量后，与每周使用者相比，每月使用者的治疗依从性高 21%（OR 1.207，95%置信区间[CI] 1.119-1.257）。同样，与每周使用者相比，每月使用者经历 30 天治疗中断的风险低 6%（HR 0.934，95%CI 0.905-0.964）。
在我们的研究中，与每周剂量相比，每月接受口服双磷酸盐治疗的患者显示出更高的药物依从率。然而，所有新使用者的双磷酸盐治疗依从性均不理想，这表明需要改进策略来提高美国军事医疗系统中口服双磷酸盐的依从性。
