title: Persistence with bisphosphonate therapy including treatment courses with multiple sequential bisphosphonates in the real world.
abstract: The real cumulative persistence probabilities with bisphosphonates after 5 years was 51.7%. Prescriptions by specialists other than gynecologists and rheumatologists (p < 0.001), male sex (p < 0.001), older age (> or =65 years) (p = 0.001), and cyclical etidronate (p < 0.001) were significantly associated with low persistence. Success rates of switching bisphosphonate were 75.6%.
  
  
  BACKGROUND
  Many patients discontinue daily bisphosphonate therapy prematurely due to the stringent dosing procedures and adverse events. Consequently, some patients are receiving two or more sequential bisphosphonates in daily practice. Our objective was to study factors associated with the real cumulative persistence with bisphosphonate therapy including treatment courses with multiple sequential drugs in the real world setting.
  
  
  METHODS
  We retrospectively analyzed 1,307 patients (male 197, female 1110) newly prescribed with bisphosphonates between January 1, 2000, and June 30, 2005.
  
  
  RESULTS
  The real cumulative persistence probabilities with bisphosphonates after 1, 3, and 5 years were 74.8%, 60.6%, and 51.7%, respectively. Switching of bisphosphonates was observed 168 times in 146 patients. Adverse events occurred 126 times in 124 patients including 86 events with gastrointestinal complaints. Univariate analysis showed that prescriptions by specialists other than gynecologists and rheumatologists (p < 0.001), male sex (p < 0.001), older age (> or =65 years) (p = 0.001), and cyclical etidronate (p < 0.001) were significantly associated with low persistence. Success rates of switching bisphosphonate were 75.6%.
  
  
  CONCLUSIONS
  Switching of bisphosphonates was not uncommon. Despite switching bisphosphonates to improve persistence, the real cumulative persistence with bisphosphonate was suboptimal, especially among patients of certain physician specialties and male sex.
authors.affiliation: Chronic Intractable Disease Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ideguchi
authors.forename: S
authors.initials: S
authors.lastname: Ohno
authors.forename: H
authors.initials: H
authors.lastname: Hattori
authors.forename: Y
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012646:Self Administration / Q000009:adverse effects / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates