title: Adherence to denosumab in the treatment of osteoporosis and its utilization in the Czech Republic.
abstract: OBJECTIVE
  The objective was to analyze adherence and current trends in utilization and prescription practice patterns of the anti-RANKL monoclonal antibody denosumab in the treatment of postmenopausal osteoporosis (OP).
  
  
  METHODS
  The prescription-based database of the General Health Insurance Company of the Czech Republic that covers approximately 60% of the Czech population (6 million) was used as the data source. Medication possession ratio (MPR) and persistence were calculated for all patients (both OP medication-naïve and medication-experienced) with postmenopausal OP from the start of their therapy with denosumab 60 mg per ml subcutaneous injection within a period between September 2011, i.e. first denosumab availability, and May 2014. Clinical data such as fractures, co-morbidities and co-medication were not analyzed.
  
  
  RESULTS
  A total of 7904 women treated with denosumab were analyzed; 93.8% of patients were identified as compliant (MPR ≥0.8) while 6.2% were non-compliant (MPR < 0.8). Persistence (base case, i.e. refill gap ≤30 days) was 59.1% after 12 months and 34.8% after 24 months. By 2013, i.e. within 2 years, denosumab became the second most utilized and most costly drug after oral bisphosphonates.
  
  
  CONCLUSIONS
  Despite relatively high MPR and persistence rate observed in denosumab treatment, adherence enhancing strategies, focused on persistence in particular, are still needed. The uptake of denosumab has been rapid, its utilization keeps rising swiftly, and denosumab already represents a significant part of the osteoporosis therapy budget.
authors.affiliation: a Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove , Charles University in Prague , Hradec Kralove , Czech Republic.
authors.forename: Leos
authors.initials: L
authors.lastname: Fuksa
authors.affiliation: a Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove , Charles University in Prague , Hradec Kralove , Czech Republic.
authors.forename: Magda
authors.initials: M
authors.lastname: Vytrisalova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D018153:Czech Republic; D016208:Databases, Factual; D000069448:Denosumab / Q000627:therapeutic use*; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D020380:Needs Assessment; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D000069448:Denosumab
keywords: Denosumab; Drug consumption; Drug prescription; Medication adherence; Medication possession ratio; Osteoporosis; Patient compliance; Persistence