Persistency with estrogen replacement therapy among hysterectomized women after the Women’s Health Initiative study

ABSTRACT

Objectives Many women are reluctant to undergo estrogen replacement therapy (ERT) and discontinue the treatment within 12 months. The aim of this study was to investigate the persistence rates of ERT in hysterectomized women over the past decade, reflecting changes in the post-Women's Health Initiative (WHI) era.

Methods We analyzed 8045 patients receiving ERT from 2004 to 2013 using the Disease Analyzer database.

Results After 12 months of follow-up, only 24.6% of patients receiving 1 mg and 24.5% of patients receiving 2 mg of oral ERT were still on treatment (p < 0.0001). The persistency rate of patients receiving <50 μg of transdermal ERT was 28.6% compared to 33.5% for patients receiving >50 μg within the 12 months of follow-up. ERT that began in 2007–2009 was associated with a higher discontinuation rate (hazard ratio 1.06, p = 0.0660) than ERT that began in 2010–2013 (hazard ratio 0.88, p = 0.0001).

Conclusions Our results indicate low persistency rates in women on ERT irrespective of the dose as well as the route of administration. However, a decrease in discontinuation rates was found when comparing women in the early vs. late post WHI era.

Key words:

• PERSISTENCY
• DISCONTINUATION
• COMPLIANCE
• ESTROGEN HORMONE REPLACEMENT THERAPY
• WHI

Conflict of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.

Source of funding Nil.

Supplementary materials available online

Figure S1a Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment starting in 2005–2006 (refill gap of 90 days)

Figure S1b Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment starting in 2007–2008 (refill gap of 90 days)

Figure S1c Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment starting in 2009–2010 (refill gap of 90 days)

Figure S1d Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment starting in 2011–2012 (refill gap of 90 days)

Figure S2a Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment starting in 2005–2006 (refill gap of 90 days)

Figure S2b Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment starting in 2007–2008 (refill gap of 90 days)

Figure S2c Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment starting in 2009–2010 (refill gap of 90 days)

Figure S2d Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment starting in 2011–2012 (refill gap of 90 days)

Figure S3 Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment (refill gap of 180 days)

Figure S4 Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment (refill gap of 180 days)

Figure S5a Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment with start in 2005–2006 (refill gap of 180 days)

Figure S5b Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment with start in 2007–2008 (refill gap of 180 days)

Figure S5c Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment with start in 2009–2010 (refill gap of 180 days)

Figure S5d Kaplan–Meier curves for persistency over 12 months of patients with oral ERT treatment with start in 2011–2012 (refill gap of 180 days)

Figure S6a Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment with start in 2005–2006 (refill gap of 180 days)

Figure S6b Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment with start in 2007–2008 (refill gap of 180 days)

Figure S6c Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment with start in 2009–2010 (refill gap of 180 days)

Figure S6d Kaplan–Meier curves for persistency over 12 months of patients with patch ERT treatment with start in 2011–2012 (refill gap of 180 days)