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Gastrointestinal events and association with initiation of treatment for osteoporosis.

Modi A, Siris ES, Tang J, Sajjan S, Sen SS - Clinicoecon Outcomes Res (2015)

Bottom Line: Post-index GI events were associated with a 75% lower likelihood of any treatment initiation (hazard ratio 0.25; 95% confidence interval 0.24-0.26).Among treated patients (n=23,311), those with post-index GI events were 39% less likely to receive a bisphosphonate versus a non-bisphosphonate (odds ratio 0.61; 95% confidence interval 0.54-0.68).GI events after OP diagnosis were associated with a decreased likelihood of OP treatment initiation and an increased likelihood of treatment initiation with a non-bisphosphonate versus a bisphosphonate.

View Article: PubMed Central - PubMed

Affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA.

ABSTRACT

Background: Preexisting gastrointestinal (GI) events may deter the use of pharmacologic treatment in patients diagnosed with osteoporosis (OP). The objective of this study was to examine the association between preexisting GI events and OP pharmacotherapy initiation among women diagnosed with OP.

Methods: The study utilized claims data from a large US managed care database to identify women aged ≥55 years with a diagnosis code for OP (index date) during 2002-2009. Patients with a claim for pharmacologic OP treatment in the 12-month pre-index period (baseline) were excluded. OP treatment initiation in the post-index period was defined as a claim for bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), calcitonin, raloxifene, or teriparatide. During the post-index period (up to 12 months), GI events were identified before treatment initiation. A time-dependent Cox regression model was used to investigate the likelihood of initiating any OP treatment. Among patients initiating OP treatment, a discrete choice model was utilized to assess the relationship between post-index GI events and likelihood of initiating with a bisphosphonate versus a non-bisphosphonate.

Results: In total, 65,344 patients (mean age 66 years) were included; 23.7% had a GI event post diagnosis and before treatment initiation. Post-index GI events were associated with a 75% lower likelihood of any treatment initiation (hazard ratio 0.25; 95% confidence interval 0.24-0.26). Among treated patients (n=23,311), those with post-index GI events were 39% less likely to receive a bisphosphonate versus a non-bisphosphonate (odds ratio 0.61; 95% confidence interval 0.54-0.68).

Conclusion: GI events after OP diagnosis were associated with a decreased likelihood of OP treatment initiation and an increased likelihood of treatment initiation with a non-bisphosphonate versus a bisphosphonate.

No MeSH data available.


Related in: MedlinePlus

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f1-ceor-7-603: Patient selection.

Mentions: A total of 65,344 women were identified for analysis (Figure 1). The average age at diagnosis was 65.7 years, and 17,828 patients (27.3%) experienced a GI event during the pre-index period (Table 1). Among all patients, the most common comorbid conditions were hypertension (48%), chronic inflammatory joint disease (21%), and fatigue (16%). Patients with a pre-index GI event were more likely to have each of the comorbid conditions evaluated than patients without a pre-index GI event (P<0.001). Patients with a pre-index GI event were more likely to use gastro-protective agents (37.8% versus 7.3%), NSAIDs (26.4% versus 19.8%), and glucocorticoids (18.8% versus 11.7%) than patients without a pre-index GI event (P<0.001). The occurrence of a GI event during the pre-index GI event was also associated with a higher mean CCI score (1.01 versus 0.52, P<0.001) and a higher rate of fractures (9.0% versus 6.0%, P<0.001).


Gastrointestinal events and association with initiation of treatment for osteoporosis.

Modi A, Siris ES, Tang J, Sajjan S, Sen SS - Clinicoecon Outcomes Res (2015)

Patient selection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664437&req=5

f1-ceor-7-603: Patient selection.
Mentions: A total of 65,344 women were identified for analysis (Figure 1). The average age at diagnosis was 65.7 years, and 17,828 patients (27.3%) experienced a GI event during the pre-index period (Table 1). Among all patients, the most common comorbid conditions were hypertension (48%), chronic inflammatory joint disease (21%), and fatigue (16%). Patients with a pre-index GI event were more likely to have each of the comorbid conditions evaluated than patients without a pre-index GI event (P<0.001). Patients with a pre-index GI event were more likely to use gastro-protective agents (37.8% versus 7.3%), NSAIDs (26.4% versus 19.8%), and glucocorticoids (18.8% versus 11.7%) than patients without a pre-index GI event (P<0.001). The occurrence of a GI event during the pre-index GI event was also associated with a higher mean CCI score (1.01 versus 0.52, P<0.001) and a higher rate of fractures (9.0% versus 6.0%, P<0.001).

Bottom Line: Post-index GI events were associated with a 75% lower likelihood of any treatment initiation (hazard ratio 0.25; 95% confidence interval 0.24-0.26).Among treated patients (n=23,311), those with post-index GI events were 39% less likely to receive a bisphosphonate versus a non-bisphosphonate (odds ratio 0.61; 95% confidence interval 0.54-0.68).GI events after OP diagnosis were associated with a decreased likelihood of OP treatment initiation and an increased likelihood of treatment initiation with a non-bisphosphonate versus a bisphosphonate.

View Article: PubMed Central - PubMed

Affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA.

ABSTRACT

Background: Preexisting gastrointestinal (GI) events may deter the use of pharmacologic treatment in patients diagnosed with osteoporosis (OP). The objective of this study was to examine the association between preexisting GI events and OP pharmacotherapy initiation among women diagnosed with OP.

Methods: The study utilized claims data from a large US managed care database to identify women aged ≥55 years with a diagnosis code for OP (index date) during 2002-2009. Patients with a claim for pharmacologic OP treatment in the 12-month pre-index period (baseline) were excluded. OP treatment initiation in the post-index period was defined as a claim for bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), calcitonin, raloxifene, or teriparatide. During the post-index period (up to 12 months), GI events were identified before treatment initiation. A time-dependent Cox regression model was used to investigate the likelihood of initiating any OP treatment. Among patients initiating OP treatment, a discrete choice model was utilized to assess the relationship between post-index GI events and likelihood of initiating with a bisphosphonate versus a non-bisphosphonate.

Results: In total, 65,344 patients (mean age 66 years) were included; 23.7% had a GI event post diagnosis and before treatment initiation. Post-index GI events were associated with a 75% lower likelihood of any treatment initiation (hazard ratio 0.25; 95% confidence interval 0.24-0.26). Among treated patients (n=23,311), those with post-index GI events were 39% less likely to receive a bisphosphonate versus a non-bisphosphonate (odds ratio 0.61; 95% confidence interval 0.54-0.68).

Conclusion: GI events after OP diagnosis were associated with a decreased likelihood of OP treatment initiation and an increased likelihood of treatment initiation with a non-bisphosphonate versus a bisphosphonate.

No MeSH data available.


Related in: MedlinePlus