Liu Ye, Arora Tarun, Zhang Jingyi, Sen Bisakha, Becker David, Sun Ruoyan, Yun Huifeng, Saag Kenneth G, Curtis Jeffrey R
University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Health Policy and Organization, UAB School of Public Health, 1665 University Boulevard, Birmingham, AL, 35233, USA.
Osteoporos Int. 2025 Sep 8. doi: 10.1007/s00198-025-07677-w.
Higher area socioeconomic level was associated with a decreased risk of romosozumab discontinuation during COVID-19 lockdown among U.S. Medicare beneficiaries. Patients in these areas were more likely to restart osteoporosis treatment post-discontinuation. Timely support for vulnerable patients is crucial for improving adherence during public health crises.
To evaluate the association between area socioeconomic (SES) vulnerability and the discontinuation of romosozumab and the impact of the COVID lockdown on osteoporosis treatment among women enrolled in the U.S. Medicare who initiated romosozumab.
Female Medicare beneficiaries aged 65 and older who initiated romosozumab between April 2019 and September 2020 were included. Discontinuation was defined as a > 60-day gap between doses. SES vulnerability was assessed using the county-level Social Vulnerability Index SES theme. A Discontinuation Risk Score (DcRS) was calculated to control for individual characteristics. A Cox proportional hazards model evaluated the association between county SES and discontinuation. Secondary analyses examined treatment restart within six months post-discontinuation.
The study included 6,777 new romosozumab users. Higher area SES level (lower vulnerability) was associated with a reduced risk of discontinuation during the COVID-19 lockdown (adjusted HR = 0.79 [0.68, 0.92] for the highest vs. lowest SES). Of 2,937 patients who discontinued, 1,816 restarted osteoporosis treatments within 6 months, including 661 switching to other medications. Patients in the highest SES group were more likely to restart osteoporosis treatment during lockdown (adjusted HR = 1.14 [1.01-1.30]) comparing with the lowest SES group, which is primarily driven by treatment switch (adjusted HR = 1.30 [1.06-1.60]).
Medicare beneficiaries in counties with higher SES level (lower vulnerability) were less likely to discontinue romosozumab during the COVID-19 lockdown and more likely to switch treatments if discontinued, resulting in shorter treatment gaps. Providing timely support to vulnerable patients is vital for maintaining treatment adherence during future public health emergencies.
在美国医疗保险受益人中，较高的地区社会经济水平与新冠疫情封锁期间停用罗莫单抗的风险降低有关。这些地区的患者在停药后更有可能重新开始骨质疏松症治疗。在公共卫生危机期间，为脆弱患者提供及时支持对于提高治疗依从性至关重要。
评估地区社会经济（SES）脆弱性与罗莫单抗停药之间的关联，以及新冠疫情封锁对开始使用罗莫单抗的美国医疗保险参保女性骨质疏松症治疗的影响。
纳入2019年4月至2020年9月期间开始使用罗莫单抗的65岁及以上女性医疗保险受益人。停药定义为剂量间隔超过60天。使用县级社会脆弱性指数SES主题评估SES脆弱性。计算停药风险评分（DcRS）以控制个体特征。Cox比例风险模型评估县SES与停药之间的关联。二次分析检查停药后六个月内的治疗重新开始情况。
该研究纳入了6777名新的罗莫单抗使用者。较高的地区SES水平（较低的脆弱性）与新冠疫情封锁期间停药风险降低有关（最高SES与最低SES相比，调整后HR = 0.79 [0.68, 0.92]）。在2937名停药的患者中，1816人在6个月内重新开始了骨质疏松症治疗，其中66名1人改用其他药物。与最低SES组相比，最高SES组的患者在封锁期间更有可能重新开始骨质疏松症治疗（调整后HR = 1.14 [1.01 - 1.30]），这主要是由治疗转换驱动的（调整后HR = 1.30 [1.06 - 1.60]）。
SES水平较高（脆弱性较低）县的医疗保险受益人在新冠疫情封锁期间停用罗莫单抗的可能性较小，如果停药则更有可能转换治疗，从而缩短治疗间隔。在未来的公共卫生紧急情况期间，为脆弱患者提供及时支持对于维持治疗依从性至关重要。
