Elsevier

Mayo Clinic Proceedings

Volume 82, Issue 12, December 2007, Pages 1493-1501
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

https://doi.org/10.1016/S0025-6196(11)61093-8Get rights and content

OBJECTIVE

To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies.

METHODS

The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance). A random-effects model was used to pool results from the selected studies.

RESULTS

Twenty-four studies were included in the meta-analysis. The pooled database-derived persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting 1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95% CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%) for treatment lasting more than 24 months. Pooled adherence rates decreased from 53% (95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting 7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12 months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to 6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months.

CONCLUSION

One-third to half of patients do not take their medication as directed. Nonadherence occurs shortly after treatment initiation. Terms and definitions need to be standardized to permit comparability of technologies designed to improve patient adherence. Prospective trials are needed to assess the relationship between adherence and patient outcomes.

Section snippets

Literature Review

We searched the PubMed and Cochrane databases of English-language articles published from January 1, 1990, to February 15, 2006. The following medical subject headings and keywords were used to identify relevant studies: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Details of the search strategy are provided in eAppendix 1 (available at www.mayoclinicproceedings.com, linked to this article). We included published

Literature Review

The initial search identified 805 studies that met the screening criteria. After title and abstract review, 286 studies met the initial inclusion criteria, and 24 were accepted for data abstraction. Figure 1 presents a diagram of the flow of citations through the review process. Analyses were based on data from 384,242 patients enrolled in 41 treatment arms. Persistence with osteoporosis medication was the most frequently reported measure (19 studies), followed by refill compliance (7 studies),

DISCUSSION

Our meta-analysis of observational studies provides the first quantitative summary of patient adherence to treatment with osteoporosis medications. We found that a substantial portion of patients—one-third to half—do not take their medication as directed. This finding was observed with database-derived persistence, adherence, and refill compliance, as well as with self-reported compliance. Our findings are consistent with previously published reviews. Gold and Silverman12 reviewed studies

CONCLUSION

One-third to half of patients do not take their medications as directed. Nonadherence occurs shortly after treatment initiation. The complex nature of patient medication-taking behavior poses a challenge in assessing the magnitude of the problem. Therefore, research is needed to standardize terms and definitions to allow comparability of technologies designed to improve patient adherence. Furthermore, additional research that assesses the relationship between adherence and patient outcomes in

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  • Cited by (0)

    This project was funded by Amgen Inc, Thousand Oaks, CA. Drs Kothawala and Miller are employees of Cerner LifeSciences, which provides consulting services to clients, including the pharmaceutical industry. Drs Badamgarav and Ryu are employees of Amgen Inc. Dr Halbert provides consulting services to the pharmaceutical industry.

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