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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

Treatment with medications for osteoporosis in the post-index period by (A) pre-index GI events and (B) post-index GI events.Note:aComparison of treatment pattern distribution among patients with and without GI events.Abbreviation: GI, gastrointestinal.
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f2-ceor-7-603: Treatment with medications for osteoporosis in the post-index period by (A) pre-index GI events and (B) post-index GI events.Note:aComparison of treatment pattern distribution among patients with and without GI events.Abbreviation: GI, gastrointestinal.

Mentions: Overall, 24% of all patients experienced a GI event in the post-index period, although GI events were more common among those who had experienced a pre-index GI event (43.4% versus 16.2%, Table 2). The rate of pre-index GI events was similar among patients who did and did not initiate treatment (bisphosphonate or non-bisphosphonate, Figure 2A). However, the occurrence of post-index GI events appeared to be associated with OP treatment initiation (Figure 2B). The proportion of patients receiving no OP treatment was 85.1% among patients with a post-index GI event versus 57.9% among patients with no post-index GI event. Among treated patients, 11.7% of patients with a post-index GI event initiated treatment with a bisphosphonate compared with 36.9% of patients without a post-index GI event.


Gastrointestinal events and association with initiation of treatment for osteoporosis.

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

Treatment with medications for osteoporosis in the post-index period by (A) pre-index GI events and (B) post-index GI events.Note:aComparison of treatment pattern distribution among patients with and without GI events.Abbreviation: GI, gastrointestinal.
© Copyright Policy
Related In: Results  -  Collection

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

f2-ceor-7-603: Treatment with medications for osteoporosis in the post-index period by (A) pre-index GI events and (B) post-index GI events.Note:aComparison of treatment pattern distribution among patients with and without GI events.Abbreviation: GI, gastrointestinal.
Mentions: Overall, 24% of all patients experienced a GI event in the post-index period, although GI events were more common among those who had experienced a pre-index GI event (43.4% versus 16.2%, Table 2). The rate of pre-index GI events was similar among patients who did and did not initiate treatment (bisphosphonate or non-bisphosphonate, Figure 2A). However, the occurrence of post-index GI events appeared to be associated with OP treatment initiation (Figure 2B). The proportion of patients receiving no OP treatment was 85.1% among patients with a post-index GI event versus 57.9% among patients with no post-index GI event. Among treated patients, 11.7% of patients with a post-index GI event initiated treatment with a bisphosphonate compared with 36.9% of patients without a post-index GI event.

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