跳到主要內容

臺灣博碩士論文加值系統

(18.97.14.82) 您好!臺灣時間:2025/02/19 09:24
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:蘇純儀
研究生(外文):SU, CHUN-YI
論文名稱:骨質疏鬆症治療藥物於真實世界的用藥順從性與處方持續性之臨床使用探討
論文名稱(外文):Adherence and Persistence with Osteoporosis Therapies in the Real World
指導教授:陳香吟陳香吟引用關係
指導教授(外文):CHEN, HSIANG-YIN
口試委員:陳揚卿姜易醇陳香吟
口試委員(外文):CHEN, YANG-CHINGCHIANG, YI-CHUNCHEN, HSIANG-YIN
口試日期:2022-07-04
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:藥學系臨床藥學碩士在職專班
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:英文
論文頁數:88
中文關鍵詞:骨質疏鬆症用藥順從性藥品持有率處方持續性
外文關鍵詞:osteoporosisadherencemedication possession ratiopersistence
相關次數:
  • 被引用被引用:0
  • 點閱點閱:278
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
研究背景
骨質疏鬆症為慢性且進展性之骨骼疾病,用藥順從性不佳與停止處方會增加骨折的風險。目前骨質疏鬆症治療藥物之用藥順從性及處方持續性探討文獻,在亞洲與臺灣地區仍未有足夠的長期追蹤藥物使用之研究。
研究目的
本研究目的為分析骨質疏鬆症病人,其治療藥物於用藥第一年至第五年之用藥順從性與處方持續性,並探討第二年用藥之相關風險因子。
研究方法
以回溯性世代觀察方式,資料蒐集自基隆長庚醫院門診醫療記錄,納入2010年至2018年期間,開始處方骨質疏鬆症治療藥物者為研究對象。
研究結果
總計有3114位病人納入研究,藥品持有率於第一年、第二年與第五年分別為73.98%、61.32% 與41.95%;處方持續性於第一年、第二年與第五年分別為45.34%、31.31%與11.92%;針對個別藥物分析,在骨質疏鬆症治療藥物中,denosumab具有最佳的處方持續性。男性病人、自費使用骨質疏鬆症藥物以及處方口服骨質疏鬆症藥物者,與用藥順從性不佳及停止處方持續性有統計顯著相關性;病人治療期間沒有更換骨質疏鬆症藥物者與用藥順從性不佳有統計顯著相關性。
結論
門診病患使用骨質疏鬆症藥物之用藥順從性與處方持續性皆為不佳,臨床上應推行有效的措施以改善用藥順從性與處方持續性。

Background
Osteoporosis is a chronic and progressive skeletal disease. Poor adherence and poor persistence of therapy are associated with the risk of fracture. Limited information is available about long-term osteoporotic treatment patterns in Asia or Taiwan.
Objective
To estimate adherence and persistence with osteoporosis treatment at 1 year to 5 years, and to evaluate predictors with non-adherence and non-persistence at 2 years.
Methods
For this retrospective study, data were extracted from outpatient records of Keelung Chang Gung Memorial Hospital. Patients who initiated osteoporosis treatment between 2010 and 2018 were recruited.
Results
A total of 3114 patients were included. The medication possession ratio at 1 year, 2 years and 5 years was 73.98%, 61.32% and 41.95%, respectively. Persistence at 1 year, 2 years and 5 years was 45.34%, 31.31% and 11.92%, respectively. In drug-specific analysis, denosumab had the highest persistence than the other medications. Male, self-pay with anti-osteoporosis agents and therapy with oral osteoporosis drugs were significantly associated with non-adherence and non-persistence. Treatment pattern without switching anti- osteoporosis medication was also significantly associated with non-adherence.
Conclusion
Adherence and persistence with anti-osteoporosis medications were suboptimal in clinic outpatient care. An effective program should be implemented to improve adherence and persistence.
中文摘要 ii
Abstract iii
Contents v
List of Tables vii
List of Figures viii

Chapter 1. Introduction 1
Chapter 2. Literature review 5
2.1 Osteoporosis 5
2.1.1 Epidemiology 5
2.1.2 Risk factors related to osteoporosis 6
2.1.3 Osteoporotic fracture 7
2.1.4 Pharmacotherapy of osteoporosis 9
2.1.4.1 Antiresorptic drugs 9
2.1.4.2 Anabolic drugs 10
2.1.4.3 Efficacy 12
2.1.4.4 Adverse events 13
2.2 Adherence and persistence with anti-osteoporosis medications 14
2.2.1 Bisphosphonates 15
2.2.2 Parenteral osteoporosis therapies 16
2.2.3 Fracture associated with adherence and persistence 17
2.2.4 Mortality associated with adherence 18
2.3 Factors affecting adherence and persistence of anti-osteoporosis medications 19
2.3.1 Condition-related factors 20
2.3.2 Patient-related factors 22
2.3.3 Therapy-related factors 22
2.3.4 Health-based system factors 24
2.3.5 Social-economic factors 24
Chapter 3. Objective 26
Chapter 4. Method 28
4.1 Study design 28
4.2 Study participants 28
4.2.1 Inclusion criteria 28
4.2.2 Exclusion criteria 29
4.3 Data collection 29
4.4 Baseline characteristics 30
4.5 Assessment of adherence 30
4.6 Assessment of persistence 31
4.7 Predictors for non-adherence and non-persistence at two years 34
4.8 Statistical analysis 34
Chapter 5. Results 36
5.1 Baseline characteristics 36
5.2 Assessment of adherence 45
5.3 Assessment of persistence 47
5.4 Predictors for non-adherence at two years 58
5.5 Predictors for non-persistence at two years 62
Chapter 6. Discussion 66
Chapter 7. Conclusion 78
Reference 79
Appendix 87

List of Tables
Table 2.4.1.1 Pharmacotherapy for treatment of osteoporosis 11
Table 5.1.1 Demographics and clinical characteristics of the study population at baseline 39
Table 5.2.1 Proportion of all patients who were adherent with any anti- osteoporosis medications 46
Table 5.3.1 Persistence to anti-osteoporosis medications in the all patients and drug-specific patients 49
Table 5.4.1 Characteristics of the subjects with adherence and non-adherence in two-year study 59
Table 5.4.2 Risk factors for non-adherence to anti-osteoporosis medications in study patients 61
Table 5.5.1 Characteristics of the subjects with persistence and non-persistence in two-year study 63
Table 5.5.2 Risk factors for non-persistence to anti-osteoporosis medications in study patients 65

List of Figures
Figure 4.5.1 Definitions of adherence and persistence 32
Figure 4.6.1 Scenario examples of persistence in all patients using a 30-day permissible gap 33
Figure 4.6.2 Scenario examples of persistence in drug-specific patients using a 30-day permissible gap 33
Figure 5.1.1 Flow chart of study population included in this study 38
Figure 5.3.1 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients using a 30-day permissible gap 50
Figure 5.3.2 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (male vs. female) using a 30-day permissible gap 51
Figure 5.3.3 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (osteoporosis vs. osteopenia) using a 30-day permissible gap 52
Figure 5.3.4 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (oral medications in the initial therapy vs. injectable medications in the initial therapy) using a 30-day permissible gap 53
Figure 5.3.5 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (NHI payment vs. self-pay) using a 30-day permissible gap 54
Figure 5.3.6 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (50-64 years vs. 65-79 years vs. ≥ 80 years) using a 30-day permissible gap 55
Figure 5.3.7 Kaplan-Meier estimate of discontinuation with anti-osteoporosis medications in the study patients (orthopedics vs. non- orthopedics) using a 30-day permissible gap 56
Figure 5.3.8 Kaplan-Meier estimate of discontinuation with each anti- osteoporosis medication in the study patients using a 30-day permissible gap 57
1.Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94:646-50.
2.Sinaki M. Postural changes in osteoporosis: musculoskeletal consequences non-pharmacological management of osteoporosis: Springer, Cham, 2017:207-17.
3.Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465-75.
4.Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393:364-76.
5.Seeman E, Compston J, Adachi J, et al. Non-compliance: the Achilles' heel of anti-fracture efficacy. Osteoporos Int. 2007;18(6):711-9.
6.Imaz I, Zegarra P, González-Enríquez J, et al. Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int. 2010;21:1943-51.
7.Adler RA, El-Hajj Fuleihan G, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31:16-35.
8.Ross S, Samuels E, Gairy K, et al. A meta-analysis of osteoporotic fracture risk with medication nonadherence. Value Health. 2011;14:571-81.
9.Hiligsmann M, Gathon HJ, Bruyere O, et al. Cost- effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value Health. 2010;13:394-401.
10.Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence:terminology and definitions. Value Health. 2008;11:44-7.
11.Hubbard T, Paradis R. Real world evidence: executive summary a new era for health care innovation. Netw Excell Heal Innov. 2015:1-19.
12.Fatoye F, Smith P, Gebrye T, et al. Real-world persistence and adherence with oral bisphosphonates for osteoporosis:a systematic review. BMJ Open. 2019;9(4):e027049.
13.Cheng TT, Yu SF, Hsu CY, et al. Differences in adherence to osteoporosis regimens: a 2-year analysis of a population treated under specific guidelines. Clin Ther. 2013;35:1005-15.
14.Lin TC, Yang CY, Yang YH, et al. Alendronate adherence and its impact on hip-fracture risk in patients with established osteoporosis in Taiwan. Clin Pharmacol Ther. 2011;90:109-16.
15.Soong YK, Tsai KS, Huang HY, et al. Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan. Osteoporos Int. 2013;24:511-21.
16.Koller G, Goetz V, Vandermeer B, et al. Persistence and adherence to parenteral osteoporosis therapies: a systematic review. Osteoporos Int. 2020; 31(11):2093-102.
17.Chan DC, Chang CHC, Lim LC et al. Association between teriparatide treatment persistence and adherence, and fracture incidence in Taiwan: analysis using the National Health Insurance Research Database. Osteoporos Int. 2016;27:2855-65.
18.Diab DL, Watts NB. Denosumab in osteoporosis. Expert Opin Drug Saf. 2014;13(2):247-53.
19.WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
20.Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29 (11):2520-26.
21.Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1):136.
22.Lin YC, Pan WH. Bone mineral density in adults in Taiwan: results of the Nutrition and Health Survey in Taiwan 2005-2008 (NAHSIT 2005-2008). Asia Pac J Clin Nutr. 2011;20(2):283-91.
23.Pouresmaeili F, Kamalidehghan B, Kamarehei M, et al. A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag. 2018;14:2029-49.
24.Stone KL, Seeley DG, Lui LY, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. 2003;18(11):1947-54.
25.Kanis JA, Cooper C, Rizzoli R, et al; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3-44.
26.Chen JS, Sambrook PN. Antiresorptive therapies for osteoporosis: a clinical overview. Nat Rev Endocrinol. 2011;8(2):81-91.
27.Li SS, He SH, Xie PY, et al. Recent progresses in the treatment of osteoporosis. Front Pharmacol. 2021;12:717065.
28.Barrionuevo P, Kapoor E, Asi N, et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab. 2019;104(5):1623-30.
29.Morley J, Moayyeri A, Ali L, et al. Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int. 2020;31(3):533-45.
30.Chen YJ, Kung PT, Chou WY, et al. Alendronate medication possession ratio and the risk of second hip fracture: an 11-year population-based cohort study in Taiwan. Osteoporos Int. 2020;31(8):1555-63.
31.Hsu CL, Chen HM, Chen HJ, et al. A national study on long-term osteoporosis therapy and risk of recurrent fractures in patients with hip fracture. Arch Gerontol Geriatr. 2020;88:104021.
32.Yu SF, Cheng JS, Chen YC, et al. Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study. BMC Geriatr.2019;19(1):290.
33.Yeam CT, Chia S, Tan HCC, et al. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int. 2018;29(12):2623-37.
34.Burkhart PV, Sabate E. Adherence to long-term therapies: evidence for action. J Nurs Scholarsh. 2003;35(3):207.
35.Cheen MH, Kong MC, Zhang RF, et al. Adherence to osteoporosis medications amongst Singaporean patients. Osteoporos Int. 2012;23(3):1053-60.
36.Richards JS, Cannon GW, Hayden CL, et al. Adherence with bisphosphonate therapy in US veterans with rheumatoid arthritis. Arthritis Care Res. 2012;64(12):1864-70.
37.Tandon VR, Sharma S, Mahajan S, et al. First Indian prospective Randomized comparative study evaluating adherence and compliance of postmenopausal osteoporotic patients for daily alendronate, weekly risedronate and monthly ibandronate regimens of bisphosphonates. J Midlife Health. 2014;5(1):29-33.
38.Tasci I, Cintosun U, Safer U, et al. Assessment of geriatric predictors of adherence to zoledronic acid treatment for osteoporosis: a prospective follow-up study. Acta Clin Belg. 2018;73(4):237-43.
39.Hall SF, Edmonds SW, Lou Y, et al. Patient-reported reasons for nonadherence to recommended osteoporosis pharmacotherapy. J Am Pharm Assoc. 2017;57(4): 503-9.
40.Gomes DC, Costa-Paiva L, Farhat FC, et al. Ability to follow anti-reabsorptive drug treatment in postmenopausal women with reduced bone mass. Menopause. 2011;18(5):531-6.
41.Kishimoto H, Maehara M. Compliance and persistence with daily, weekly, and monthly bisphosphonates for osteoporosis in Japan: analysis of data from the CISA. Arch Osteoporos. 2015;10:231.
42.Lindsay BR, Olufade T, Bauer J, et al. Patient-reported barriers to osteoporosis therapy. Arch Osteoporos. 2016;11(1):19.
43.Chiu CK, Kuo MC, Yu SF, et al. Adherence to osteoporosis regimens among men and analysis of risk factors of poor compliance: a 2-year analytical review. BMC Musculoskelet Disord. 2013;14:276.
44.Foster SA, Foley KA, Meadows ES, et al. Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int. 2011;22(2):551-7.
45.Wade SW, Satram-Hoang S, Stolshek BS. Long-term persistence and switching patterns among women using osteoporosis therapies: 24- and 36-month results from POSSIBLE US™. Osteoporos Int. 2014;25(9):2279-90.
46.Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
47.Kobayashi K, Ando K, Machino M, et al. Persistence of denosumab therapy among patients with osteoporosis. Asian Spine J. 2020;14(4):453-8.
48.Briot K, Schott AM, Sanchez JP, et al. High persistence over two years with denosumab among postmenopausal women with osteoporosis in France: A prospective cohort study. Bone. 2021;146:115890.
49.Hadji P, Papaioannou N, Gielen E, et al. Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int. 2015;26(10): 2479-89.
50.Yu SF, Chou CL, Lai HM, et al. Adherence to anti-osteoporotic regimens in a Southern Taiwanese population treated according to guidelines: a hospital-based study. Int J Rheum Dis. 2012;15(3):297-305.
51.Yu SF, Yang TS, Chiu WC, et al. Non-adherence to anti-osteoporotic medications in Taiwan: physician specialty makes a difference. J Bone Miner Metab. 2013;31(3):351-9.
52.Siris ES, Fan CS, Yang X, et al. Association between gastrointestinal events and compliance with osteoporosis therapy. Bone Rep. 2015;4:5-10.
53.Modi A, Sajjan S, Michael Lewiecki E, et al. Relationship between gastrointestinal events and compliance with osteoporosis therapy: an administrative claims analysis of the US managed care population. Clin Ther. 2016;38(5):1074-80.
54.Modi A, Siris S, Yang X, et al. Association between gastrointestinal events and persistence with osteoporosis therapy: analysis of administrative claims of a U.S. managed care population. J Manag Care Spec Pharm. 2015;21(6):499-506.
55.Jacob L, Dreher M, Kostev K, et al. Increased treatment persistence and its determinants in women with osteoporosis with prior fracture compared to those without fracture. Osteoporos Int. 2016;27(3):963-9.
56.Orimo H, Sato M, Kimura S, et al. Understanding the factors associated with initiation and adherence of osteoporosis medication in Japan: an analysis of patient perceptions. Osteoporos Sarcopenia. 2017;3(4):174-84.
57.Wang CY, Fu SH, Yang RS, et al. Timing of anti-osteoporosis medications initiation after a hip fracture affects the risk of subsequent fracture: a nationwide cohort study. Bone. 2020;138:115452.
58.Anastasilakis AD, Polyzos SA, Makras P, et al. Clinical features of 24 patients with rebound-associated vertebral fractures after denosumab discontinuation: systematic review and additional cases. J Bone Miner Res. 2017;32(6):1291-6.
59.Anastasilakis AD, Yavropoulou MP, Makras P, et al. Increased osteoclastogenesis in patients with vertebral fractures following discontinuation of denosumab treatment. Eur J Endocrinol. 2017;176(6):677-83.
60.Zanchetta MB, Boailchuk J, Massari F, et al. Significant bone loss after stopping long-term denosumab treatment: a post FREEDOM study. Osteoporos Int. 2018;29(1):41-7.
61.Martin J, Viprey M, Castagne B, et al. Interventions to improve osteoporosis care: a systematic review and meta-analysis. Osteoporos Int. 2020;31(3):429-46.
62.Wu CH, Tu ST, Chang YF, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone. 2018;111:92-100.
63.Wu CH, Kao IJ, Hung WC, et al. Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int. 2018;29(6):1227-42.
64.Delbar A, Pflimlin A, Delabrière I, et al. Persistence with osteoporosis treatment in patients from the Lille University Hospital Fracture Liaison Service. Bone. 2021;144:115838.
65.Park JH, Park EK, Koo DW, et al. Compliance and persistence with oral bisphosphonates for the treatment of osteoporosis in female patients with rheumatoid arthritis. BMC Musculoskelet Disord. 2017;18(1):152.
電子全文 電子全文(網際網路公開日期:20270721)
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊