Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, NG5 1PB, UK.
School of Health and Related Research, Regent Court (ScHARR), University of Sheffield, Sheffield, S1 4DA, UK.
Osteoporos Int. 2022 Jun;33(6):1223-1233. doi: 10.1007/s00198-022-06350-w. Epub 2022 Feb 21.
Bisphosphonates are effective in preventing fragility fractures; however, high rates of adherence are needed to preserve clinical benefits.
To investigate persistence and compliance to oral and intravenous bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate).
Searches of 12 databases, unpublished sources, and trial registries were conducted, covering the period from 2000 to April 2021. Screening, data extraction, and risk of bias assessment (Cochrane Collaboration risk-of-bias tool 1.0 & ROBINS-I) were independently undertaken by two study authors. Randomised controlled trials (RCTs) and observational studies that used prescription claim databases or hospital medical records to examine patients' adherence were included. Network meta-analyses (NMA) embedded within a Bayesian framework were conducted, investigating users' likelihood in discontinuing bisphosphonate treatment. Where meta-analysis was not possible, data were synthesised using the vote-counting synthesis method.
Fifty-nine RCTs and 43 observational studies were identified, resulting in a total population of 2,656,659 participants. Data from 59 RCTs and 24 observational studies were used to populate NMAs. Zoledronate users were the least likely to discontinue their treatment HR = 0.73 (95%CrI: 0.61, 0.88). Higher rates of compliance were observed in those receiving intravenous treatments. The paucity of data and the heterogeneity in the reported medication possession ratio thresholds precluded a NMA of compliance data.
Users of intravenously administered bisphosphonates were found to be the most adherent to treatment among bisphosphonates' users. Patterns of adherence will permit the more precise estimation of clinical and cost-effectiveness of bisphosphonates.
PROSPERO 2020 CRD42020177166.
双膦酸盐可有效预防脆性骨折；然而，需要较高的依从率才能保持临床获益。
研究口服和静脉用双膦酸盐（阿仑膦酸钠、伊班膦酸钠、利塞膦酸钠和唑来膦酸）的持续使用和依从性。
对 2000 年至 2021 年 4 月期间的 12 个数据库、未发表的资料和试验登记处进行了检索。两位研究作者独立进行了筛选、数据提取和偏倚风险评估（Cochrane 协作风险偏倚工具 1.0 和 ROBINS-I）。纳入了使用处方数据库或医院病历来检查患者依从性的随机对照试验（RCT）和观察性研究。使用贝叶斯框架内的网络荟萃分析（NMA），调查使用者停止双膦酸盐治疗的可能性。如果无法进行荟萃分析，则使用投票计数综合法对数据进行综合。
确定了 59 项 RCT 和 43 项观察性研究，总共有 2656659 名参与者。来自 59 项 RCT 和 24 项观察性研究的数据用于填充 NMA。唑来膦酸使用者最不可能停止治疗（HR=0.73，95%CrI：0.61，0.88）。静脉治疗的依从性更高。由于数据缺乏和报告的药物维持率阈值的异质性，无法对依从性数据进行 NMA。
静脉用双膦酸盐使用者的治疗依从性高于其他双膦酸盐使用者。依从模式将更精确地估计双膦酸盐的临床和成本效益。
PROSPERO 2020 CRD42020177166。
