title: Influence of patient perceptions and preferences for osteoporosis medication on adherence behavior in the Denosumab Adherence Preference Satisfaction study.
abstract: OBJECTIVE
  This study aims to evaluate patient perceptions of subcutaneous denosumab or oral alendronate in postmenopausal women with or at risk for osteoporosis and how these perceptions influence adherence.
  
  
  METHODS
  Postmenopausal women with low bone mass were randomized to denosumab 60 mg every 6 months for 1 year (treatment period 1 [TP1]) followed by alendronate 70 mg once weekly for 1 year (treatment period 2 [TP2]), or vice versa. Beliefs about Medicines Questionnaire data were collected at baseline and at 6, 12, 18, and 24 months; a necessity-concerns differential (NCD) was calculated for each time point. Logistic regression analyses were performed to evaluate the influences of baseline characteristics on nonadherence.
  
  
  RESULTS
  Participants included 250 women (alendronate/denosumab, n = 124; denosumab/alendronate, n = 126). During TP1, the NCD at month 6 was higher with denosumab than with alendronate (P = 0.0076). In TP2, the NCD was higher for women switched to denosumab than for women switched to alendronate at 6 months (P = 0.0126) and 12 months (P = 0.4605). Denosumab was preferred to alendronate regardless of treatment sequence (P < 0.0001). Covariate analysis revealed that higher TP2 baseline necessity scores were associated with lower odds of nonadherence (P = 0.0055), whereas higher concerns about medication scores were associated with higher odds of nonadherence (P = 0.0247). Higher NCD scores were also associated with lower odds of nonadherence (P = 0.0015).
  
  
  CONCLUSIONS
  Participants preferred denosumab to alendronate while on treatment and had more positive perceptions of denosumab than alendronate. These perceptions were associated with better adherence.
authors.affiliation: From the 1University of British Columbia, Vancouver, BC, Canada; 2Amgen Inc., Thousand Oaks, CA; 3Internal Medicine Associates, Fargo, ND; 4OB-GYN Associates of Mid-Florida, PA, Leesburg, FL; 5QD Research Inc., Granite Bay, CA; and 6University College London, London, UK.
authors.forename: David L
authors.initials: DL
authors.lastname: Kendler
authors.forename: David
authors.initials: D
authors.lastname: Macarios
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lillestol
authors.forename: Alfred
authors.initials: A
authors.lastname: Moffett
authors.forename: Sacha
authors.initials: S
authors.lastname: Satram-Hoang
authors.forename: Joice
authors.initials: J
authors.lastname: Huang
authors.forename: Primal
authors.initials: P
authors.lastname: Kaur
authors.forename: En-Tzu
authors.initials: ET
authors.lastname: Tang
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Wagman
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
mesh_terms: D000284:Administration, Oral; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D000069448:Denosumab; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007279:Injections, Subcutaneous; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D057240:Patient Preference; D010465:Perception; D011795:Surveys and Questionnaires
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D000069448:Denosumab; D019386:Alendronate