Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, 833 S Wood Street Room 241, Chicago, IL 60612, USA.
Osteoporos Int. 2012 Mar;23(3):1103-13. doi: 10.1007/s00198-011-1843-3. Epub 2011 Dec 8.
The study investigated the real-world relationship between teriparatide adherence and persistence and fracture outcomes in a US claims database. Fracture risk was estimated to decrease as adherence and persistence increased for any clinical, vertebral, and non-vertebral fractures. Greater emphasis on programs to increase patient adherence may improve clinical outcomes.
Adherence to osteoporosis treatment is essential for achieving optimal therapeutic outcomes. Previous findings from clinical trials and observational studies demonstrate that longer teriparatide (TPTD) exposure is associated with fewer fractures. The study aim was to investigate real-world relationships between TPTD adherence and persistence and fracture outcomes.
The Thomson Reuters MarketScan® database, 2004-2008, was used to identify TPTD users with continuous enrollment 12 months pre- and 24 months post-TPTD initiation. Post-index fractures included vertebral and non-vertebral. Adherence (medication possession ratio, MPR) groups were defined as high (MPR ≥ 0.80), medium (0.5 ≤ MPR < 0.8), and low (MPR < 0.5). Persistence groups were defined by periods 1-6, 7-12, 13-18, and 19-24 months. Logistic regressions modeled fracture risk for any clinical, hip, vertebral, and non-vertebral fractures, controlling for patient characteristics, insurance and healthcare provider types, Charlson comorbidity index, bone mineral density screening, medication use, and fracture history.
Among 3,587 TPTD patients (mean age 68.9 years; 91% female), fracture risk was lowest in high MPR patients in all models except hip (OR = 1.17; p = 0.64). Medium versus high MPR was a significant risk factor for any fracture (OR = 1.49; p = 0.004) and non-vertebral fracture (OR = 1.45; p = 0.014); low-MPR was a significant risk factor for any fracture (OR = 1.64; p < 0.01), vertebral fracture (OR = 2.56; p = 0.001), and non-vertebral fracture (OR = 1.44; p = 0.013). Persistence of 1-6 months versus 19-24 months was associated with higher risk for any clinical (OR = 1.88, p < 0.001), vertebral (OR = 3.69; p < 0.001), and non-vertebral fracture (OR = 1.51; p = 0.011), but not hip (OR = 1.93; p = 0.08).
Fracture risk decreased as TPTD adherence and persistence increased for any clinical, vertebral, and non-vertebral fractures.
研究在美国索赔数据库中，特立帕肽依从性和持久性与骨折结局之间的真实关系。研究结果表明，无论临床、椎体还是非椎体骨折，随着依从性和持久性的增加，骨折风险都会降低。因此，更加重视提高患者依从性的项目可能会改善临床结果。
使用 2004-2008 年汤姆森路透市场扫描（Thomson Reuters MarketScan®）数据库，确定特立帕肽（TPTD）使用者，其在指数前 12 个月和指数后 24 个月持续入组。包括椎体和非椎体在内的骨折均被定义为骨折事件。根据药物使用比例（MPR）将依从性分为高（MPR≥0.80）、中（0.5≤MPR＜0.8）和低（MPR＜0.5）。将持久性分为 1-6、7-12、13-18 和 19-24 个月。采用逻辑回归模型对任何临床、髋部、椎体和非椎体骨折的风险进行了分析，同时控制了患者特征、保险和医疗服务提供者类型、Charlson 合并症指数、骨密度筛查、药物使用和骨折史等混杂因素。
在 3587 例特立帕肽患者中（平均年龄 68.9 岁，91%为女性），除髋部外（比值比[OR] = 1.17，p = 0.64），高 MPR 患者在所有模型中骨折风险最低。中 MPR 与高 MPR 相比是所有骨折（OR = 1.49，p = 0.004）和非椎体骨折（OR = 1.45，p = 0.014）的显著危险因素；低 MPR 是所有骨折（OR = 1.64，p＜0.01）、椎体骨折（OR = 2.56，p = 0.001）和非椎体骨折（OR = 1.44，p = 0.013）的显著危险因素。1-6 个月的持久性与 19-24 个月的持久性相比，任何临床（OR = 1.88，p＜0.001）、椎体（OR = 3.69，p＜0.001）和非椎体（OR = 1.51，p = 0.011）骨折风险更高，但髋部骨折风险无显著差异（OR = 1.93，p = 0.08）。
无论临床、椎体还是非椎体骨折，特立帕肽的依从性和持久性越高，骨折风险越低。
