Patient Compliance: The Achilles Heel of Therapeutics
Failure to take medication for the length of time prescribed is a major challenge in contemporary therapeutics. Compliance and persistence are no different for patients who have osteoporosis. Lack of compliance and persistence is associated with higher rates of fracture and, in most instances, is observed within 3 months of treatment initiation.
In a large study (N = 44,635) of patient medication compliance with 3 bisphosphonates, the majority of patients discontinued treatment:
Alendronate once weekly (64%);
Risedronate once weekly (66.5%); and
Ibandronate once monthly (68.2%).
The time for 50% of the alendronate-treated patients to discontinue therapy was longer (109 days) than that for risedronate-treated patients (95 days) or ibandronate-treated patients (58 days). Conversely, in another study, mean persistence among 22,718 patients taking risedronate 35 mg weekly was 103 days, and 92 days in 3309 patients taking monthly ibandronate. Thus, claims that one drug is better than another on the basis of a perceived relationship between dosing regimen and patient compliance are difficult to substantiate. Compliance is a problem with all drugs, and dosing regimens are unlikely to be solely responsible for this problem.
The results of this conference demonstrate that exciting advances are taking place with regard to the discovery of new therapeutic agents to reduce the progression of bone fragility and, in some cases, to reverse it. There were no "big bangs" at this meeting, but this is a good thing: Big bangs are often firecrackers that light up the sky then fizzle to earth with a whimper. Clear evidence of new and effective therapeutic modalities such as zoledronic acid is becoming available, and advances in our understanding of the molecular mechanisms responsible for bone remodeling are indeed opening doors to new approaches to treatment, such as recent work with newer agents as summarized above. Many challenges remain, but there is progress.
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Cite this: Highlights of the 28th Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) - Medscape - Jan 10, 2007.