Journal Article

AB0287 FACTORS AFFECTING PERSISTENCE OF DENOSUMAB TREATMENT IN PATIENTS WITH OSTEOPOROSIS: A RETROSPECTIVE COHORT STUDY

Paredes, S., Taverner, D., Llop, C., Costa, E., Llop, D., Pàmies, A., Tomas, C.

2024

Overview

Background:Perseverance in pharmacological treatment for osteoporosis is a key factor in fracture prevention. Denosumab has demonstrated superior persistence compared to other anti-osteoporotic drugs in previous studies. Patient-related factors may influence treatment persistence.Objectives:To describe the characteristics of a cohort of patients undergoing denosumab treatment. To assess clinical and/or demographic characteristics that are significantly associated with treatment persistence.Methods:Patients diagnosed with osteoporosis aged over 50, visited in Rheumatology outpatient clinics of three hospitals in Tarragona, who were prescribed denosumab between January 2013 and December 2023 and had received at least two doses of denosumab. Clinical and demographic data were collected from the patients’ medical records. Logistical regression analysis was conducted to examine the relationship between different factors and treatment persistence. The variables studied included age, gender, polypharmacy, Charlson index, cognitive status, fracture risk, use of psychoactive drugs, previous osteoporotic fractures and previous osteoporosis treatments.Results:A total of 854 patients were recruited. Patients lost to treatment due to death (130 patients) and withdrawal due to improvement according to medical criteria (108) were excluded. 616 patients were analyzed. The characteristics of these patients are shown in Table 1. A total of 468 patients continued with treatment (76%) while 148 discontinued it (24%). The mean follow-up time was 59 months (minimum 12 – maximum 144). Variables significantly associated with lower treatment discontinuation were previous osteoporosis treatment (OR=0.67; CI: 0.48-0.93); polypharmacy with 5-10 drugs (OR 0.66; CI 0.45-0.95); polypharmacy with more than 10 drugs (OR 0.6; CI 0.37-0.97). The variable significantly associated with higher discontinuation was dementia (OR 1.96; CI 1.34-2.89).Conclusion:The studied cohort comprises an aging population with high comorbidity, a significant presence of dementia, and polypharmacy. Denosumab treatment persistence is significantly influenced by patient’s cognitive status, use of more than 5 drugs, and having received previous osteoporosis treatments. These factors should be considered when initiating long-term treatments, reevaluating the type of treatment, and reinforcing follow-up for these patients.Table 1.Characteristics of the analyzed populationN = 616Age (median, IQR)81 (74 – 87)Sex (n women, %)560, 90.90%Cognitive state (n, %) Good470, 76.30% Mild dementia115, 18.66% Moderate dementia30, 4.87%Densitometry at diagnosis (yes, %)416, 67.53%Column densitometry values T-score (median, IQR)-3.10 (-3.70 - -2.37)Hip densitometry values T-score (median, IQR)-2.50 (-2.90 - -1.90)Vitamin D values before starting treatment ng/dl (median, IQR)33.80 (28 – 44)Osteoporosis risk (n, %) High263, 42.69% Very high353, 57.31%Charlson index (median, IQR)4 (3 – 6)Psychoactive drugs (yes, %)311, 50.49%Corticoids (n, %) Up to 5 mg prednisone63, 10.22% More than 5 mg prednisone27, 4.38% No524, 85.06%Polypharmacy (n, %) Up to 5 different drugs205, 33.28% Between 5 and 10293, 47.56% More than 10116, 18.83%Previous osteoporotic fracture (n, %) Other fractures23, 3.73% Hip122, 19.81% Vertebral204, 33.11% No186, 30.19%Previous osteoporosis treatment (n, %) IV Bisphosphonates25, 4.06% Oral bisphosphonates213, 34.58% Teriparatide102, 16.56% No274, 44.48%REFERENCES:[1]   Reyes C, et al. One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int. 2017 Oct;28(10):2997-3004.[2]   Llop C, et al. Cumplimiento y permanencia de los tratamientos para la osteoporosis en pacientes con fractura de cadera. Aten primaria 2020;52(9):659-660.Acknowledgements:NIL.Disclosure of Interests:Silvia Paredes Galapagos, Novartis, Lilly, Amgen, Abbvie, Delia Taverner Janssen, Galapagos, Abbvie, Novartis, Ester Costa Janssen, Galapagos, Anna Pàmies Lilly, Galapagos, Amgen y Novartis, Carles Tomas: None declared, Didac Llop: None declared, Carles Llop: None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited
• Subject: Aging / Bisphosphonates / Bone / Cohort analysis / Comorbidity / Corticosteroids / Dementia / Dementia disorders / Demography / Densitometry / Drug therapy / Drugs / Fractures / Medical records / Monoclonal antibodies / Observational studies/ registry / Osteoporosis / Parathyroid hormone / Patients / Polypharmacy / Population studies / Prednisone / Prognostic factors / Psychotropic drugs / Rheumatology / Scientific Abstracts / Vertebrae / Vitamin D / Withdrawal