(89) Utilization Patterns and Predictors of Persistence for Anti-Osteoporosis Treatment Initiators in Denmark: A Population-Based Cohort Study

Publication Number: 420

Background: Comprehensive description of users of different osteoporosis treatment (OTx) medication and predictors for persistence in the routine clinical practice is sparse.

Objectives: We described baseline characteristics, persistence patterns, and predictors of persistence of new users of oral bisphosphonates (alendronate, risedronate, ibandronate) and denosumab.

Methods: Population-based cohort study using Danish health registries during 2010-2018. A 60-day grace period was used to define non-persistence.

Results: We included users of alendronate (n=128,590), risedronate (n=892), ibandronate (n=5,855), and denosumab (n=16,469), aged>=50 years. The 1-year persistence (95% CI) was 68.3% (68.0-68.5) in alendronate users; 39.4% (36.1-43.0) in risedronate users; 56.6% (55.2-58.0) in ibandronate users; and 83.7% (83.1-84.3) in denosumab users. The 2-year persistence was 58.7% (58.5-59.1) in alendronate users; 28.0% (24.5-31.8) in risedronate users; 42.9% (41.3-44.4) in ibandronate users; and 71.9% (71.0-72.7) in denosumab users. The 4-year persistence was 46.5%, 16.1%, 29.5%, and 56.9%, respectively. Later years of treatment initiation were predictors of lower persistence for alendronate (adjusted Odds ratio (OR) was 0.86 (0.81-0.91) in 2016 vs 2010), but not for risedronate (OR was 1.56 (0.60-4.06), ibandronate (OR was 0.91 (0.71-1.19) or denosumab (OR was 1.11 (0.87-1.43). Older age and region of residence were predictors of persistence for all medications. Being female was a predictor of persistence for all medications expect ibandronate. Dementia was a predictor of higher persistence for alendronate but not denosumab; the opposite was observed for prior OTx. Comorbidities such as COPD, chronic renal impairment and diabetes were predictors of lower persistence for alendronate, but not denosumab. Use of anxiolytics, sedatives and opioids were predictors of lower, whereas use of statins and antipsychotics were predictors of higher persistence of both alendronate and denosumab

Conclusions: Persistence with initial treatment was highest after 1 year, decreasing afterwards. Persistence was highest for denosumab followed by alendronate. We identified several predictors of treatment persistence which could help target subgroups of patients in terms of social and healthcare support.