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.
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Article Info
Footnotes
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.
Identification
Copyright
© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
