Adherence and persistence in patients with postmenopausal osteoporosis treated with raloxifene

Abstract

Objective A major impediment in osteoporosis care is poor therapeutic adherence. Real-life surveys show that adherence and persistence with oral bisphosphonates decrease to 30–60% within 1 year. The aim of this study was to analyze the adherence and persistence with raloxifene in patients visiting our outpatient clinic.

Material and methods A total of 342 patients were evaluated from the conventional osteoporosis practice receiving treatment with raloxifene. Patient self-reporting was combined with the medication possession ratio (MPR) assessed via prescription refill counts. In addition, persistence and other self-reported and patient file-based data were assessed.

Results The final analysis comprised 300 patients with a mean age of 66.3 years (standard deviation ± 7.2 years). At 6 months 84%, at 12 months 81%, at 24 months 78% and at 36 months 77% of patients were persistent with therapy according to patients' self-reports. If MPR and self-reported data were combined, 56%, 48% and 35% of patients remained on therapy at 12, 24 and 36 months, respectively. The mean duration of therapy was 19 months with a mean MPR of 52.8%. Finally, 31.7% of all patients were classified as adherent. Significant correlation to adherence was found for tolerability and motivational factors.

Conclusion This study revealed that approximately half of the patients treated with raloxifene in regular clinical practice stay on therapy for the first 2 years. Furthermore, the patients do not adhere sufficiently to the recommended dosage, and reduced clinical efficacy in clinical practice is presumable. The reasons for non-adherence comprise tolerability and motivational factors but further investigation is needed.

Key words:

• ADHERENCE
• PERSISTENCE
• COMPLIANCE
• OSTEOPOROSIS
• RALOXIFENE

Acknowledgements

We would like to thank Dr Olaf Hars for the statistical analysis. Preliminary parts of this article have been presented at the ASBMR annual meeting 2009 in Denver, Colorado. Furthermore, the study was awarded with the ‘Christian Lauritzen-Award’ in Hamburg, November 2009, donated by the German Menopause Society at their annual meeting.

Conflict of interest The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. All authors declare that they have participated in the conception and writing of the manuscript and that they have seen and approved the final version. V. Ziller has served as a speaker for Eli Lilly, P&G, Novartis, Daiichi Sankyo, Sanofi Aventis; P. Hadji has served as a speaker and consultant for Eli Lilly, P&G, Novartis, Daiichi Sankyo, GSK, Merck; Dr Ziller has received lecture fees from Daiichi Sankyo and Eli Lilly; Mrs Wetzel, Mr Kyvernitakis and Dr Seker-Pektas state that they have no conflicts of interest.

Source of funding This study was supported by an unrestricted research grant from Daiichi Sankyo Germany GmbH.