Kyvernitakis I, Kostev K, Kurth A, Albert U S, Hadji P
Department of Endocrinology, Reproductive Medicine and Osteoporosis, Philipps-University of Marburg, Baldingerstr. 1, 35043, Marburg, Germany,
Osteoporos Int. 2014 Dec;25(12):2721-8. doi: 10.1007/s00198-014-2810-6. Epub 2014 Jul 11.
This analysis investigated the persistence of teriparatide for treatment of osteoporosis in 829 patients according to gender and health care provider treated with teriparatide. This study showed that female patients were less persistent than males and those patients treated in the practices of orthopedic surgeons were more treatment persistent than patients treated in general practitioner (GP) practices.
The optimal persistency of teriparatide (TPTD) is of the upmost importance to ensure fracture risk reduction and pain relief. Data reporting on gender-specific or health care provider-dependent differences on health care provider-dependent persistence is currently lacking.
We analyzed a large dataset extracted from the Disease Analyzer database (IMS Health, Germany). Out of a dataset of 15 million patients, we identified patients with osteoporosis who received first-time teriparatide prescriptions from January 2005 to December 2012.
All 829 patients (677 females and 152 males) were included in the study. The patients were treated by 214 general practitioners (GPs) and 143 orthopedic surgeons. After 18 months of follow-up, 39.5 % of the female and 34 % of the male patients discontinued their treatment (p = 0.0308). We found a significant difference in the discontinuation rate of patients treated by orthopedic surgeons (35.0 %) compared to patients treated by GPs (44.2 %) (p = 0.0445). Additionally, at the end of the 18 months of follow up, 39.4 % of female and 47.8 % of male patients were still on treatment. We found a highly significant decreased risk for treatment discontinuation in patients with fractures prior to treatment initiation compared to those without such fractures (hazard ratio (HR) 0.77; 95 % confidence interval (CI) 0.66-0.90). There was a significantly increased risk of treatment discontinuation for female patients (HR 1.38; 95 % CI 1.10-1.74) compared to male patients.
In conclusion, female patients presented higher discontinuation rates of TPTD compared to males. Patients treated in the practices of orthopedic surgeons were more persistent than patients treated in GP practices. TPTD persistence in patients with osteoporosis is higher than with antiresorptives but is still suboptimal and needs to be improved to ensure fracture risk reductions comparable to randomized controlled trial (RCT) results.
本分析根据性别以及接受特立帕肽治疗的医疗服务提供者，调查了829例骨质疏松症患者使用特立帕肽治疗的持续性。本研究表明，女性患者的持续性低于男性，并且在骨科医生处接受治疗的患者比在全科医生（GP）处接受治疗的患者治疗持续性更高。
特立帕肽（TPTD）的最佳持续性对于确保降低骨折风险和缓解疼痛至关重要。目前缺乏关于性别特异性或医疗服务提供者依赖性差异对医疗服务提供者依赖性持续性影响的数据报告。
我们分析了从疾病分析器数据库（德国艾美仕市场研究公司）提取的一个大型数据集。在1500万患者的数据集中，我们识别出2005年1月至2012年12月首次接受特立帕肽处方的骨质疏松症患者。
所有829例患者（677例女性和152例男性）均纳入研究。这些患者由214名全科医生和143名骨科医生治疗。随访18个月后，39.5%的女性患者和34%的男性患者停止治疗（p = 0.0308）。我们发现，与全科医生治疗的患者（44.2%）相比，骨科医生治疗的患者停药率存在显著差异（35.0%）（p = 0.0445）。此外，在随访18个月结束时，39.4%的女性患者和47.8%的男性患者仍在接受治疗。我们发现，与治疗开始前无骨折的患者相比，治疗开始前有骨折的患者停药风险显著降低（风险比（HR）0.77；95%置信区间（CI）0.66 - 0.90）。与男性患者相比，女性患者停药风险显著增加（HR 1.38；95% CI 1.10 - 1.74）。
总之，与男性相比，女性患者的特立帕肽停药率更高。在骨科医生处接受治疗的患者比在全科医生处接受治疗的患者持续性更高。骨质疏松症患者使用特立帕肽的持续性高于抗吸收药物，但仍未达到最佳状态，需要改善以确保骨折风险降低程度与随机对照试验（RCT）结果相当。
