ORIGINAL ARTICLESystematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis
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.