title: Early (1-year) Discontinuation of Different Anti-osteoporosis Medications Compared: A Population-Based Cohort Study.
abstract: Although a number of reports suggest very low persistence with oral bisphosphonates, there is limited data on persistence with other anti-osteoporosis medications. We compare rates of early discontinuation (in the first year) with all available outpatient anti-osteoporosis drugs in Catalonia, Spain. We conducted a population-based retrospective cohort study using data from the SIDIAP database. SIDIAP contains computerized primary care records and pharmacy dispensing data for >80 % of the population of Catalonia (>5 million people). All SIDIAP participants starting an anti-osteoporosis drug between 1/1/2007 and 30/06/2011 (with 2 years wash-out) were included. We modelled persistence as the time between first prescription and therapy discontinuation (refill gap of at least 6 months) using Fine and Gray survival models with competing risk for death. We identified 127,722 patients who started any anti-osteoporosis drug in the study period. The most commonly prescribed drug was weekly alendronate (N = 55,399). 1-Year persistence ranges from 40 % with monthly risedronate to 7.7 % with daily risedronate, and discontinuation was very common [from 49.5 % (monthly risedronate) to 84.4 % (daily risedronate)] as was also switching in the first year of therapy [from 2.8 % (weekly alendronate) to 10 % (daily alendronate)]. Multivariable-adjusted models showed that only monthly risedronate had better one-year persistence than weekly alendronate and teriparatide equivalent, whilst all other therapies had worse persistence. Early discontinuation with available anti-osteoporosis oral drugs is very common. Monthly risedronate, weekly alendronate, and daily teriparatide are the drugs with the best persistence, whilst daily oral drugs have 40-60 % higher first-year discontinuation rates compared to weekly alendronate.
authors.affiliation: GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain.|Institut Català de la Salut, Universitat de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Carbonell-Abella
authors.affiliation: GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pages-Castella
authors.affiliation: Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK.|MRC Lifecourse Epidemiology Unit, Southampton, UK.
authors.forename: M K
authors.initials: MK
authors.lastname: Javaid
authors.affiliation: Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Nogues
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Farmer
authors.affiliation: Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK.|MRC Lifecourse Epidemiology Unit, Southampton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: GREMPAL Research Group, IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain. daniel.prietoalhambra@ndorms.ox.ac.uk.|Oxford NIHR BRU, NDORMS, University of Oxford, Oxford, UK. daniel.prietoalhambra@ndorms.ox.ac.uk.|MRC Lifecourse Epidemiology Unit, Southampton, UK. daniel.prietoalhambra@ndorms.ox.ac.uk.|Musculoskeletal Research Unit, FIMIM, Parc Salut Mar, and RETICEF, Barcelona, Spain. daniel.prietoalhambra@ndorms.ox.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Prieto-Alhambra
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013030:Spain; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents
keywords: Catalonia; Electronic health records; Epidemiology; Medication adherence; Osteoporosis; Primary health care