Florence Mercier

Relationship between compliance and persistence with osteoporosis medications and fracture risk in primary health care in France: A retrospective case—control analysis

BACKGROUND Nonadherence to treatment is an important determinant of long-term outcomes in women with osteoporosis. OBJECTIVES This study was conducted to investigate the association between adherence and osteoporotic fracture risk and to identify optimal thresholds for good compliance and persistence. A secondary objective was to perform a preliminary evaluation of the cost consequences of adherence. METHOD This was a retrospective case-control analysis. Data were derived from the Thales prescription database, which contains information on >1.6 million patients in the primary health care setting in France. Cases were women aged >or=50 years who had an osteoporosis-related fracture in 2006. For each case, 5 matched controls were randomly selected. Both compliance and persistence aspects of treatment adherence were examined. Compliance was estimated based on the medication possession ratio (MPR). Persistence was calculated as the time from the initial filling of a prescription for osteoporosis medication until its discontinuation. RESULTS The mean (SD) MPR was lower in cases compared with controls (58.8% [34.7%] vs 72.1% [28.8%], respectively; P < 0.001). Cases were more likely than controls to discontinue osteoporosis treatment (50.0% vs 25.3%; P < 0.001), yielding a significantly lower proportion of patients who were still persistent at 1 year (34.1% vs 40.9%; P < 0.001). MPR was the best predictor of fracture risk, with an area under the receiver-operating-characteristic curve that was higher than that for persistence (0.59 vs 0.55). The optimal MPR threshold for predicting fracture risk was >or=68.0%. Compared with less-compliant women, women who achieved this threshold had a 51% reduction in fracture risk. The difference in annual drug expenditure between women achieving this threshold and those who did not was approximately euro300. The optimal threshold for persistence with therapy was at least 6 months. Attaining this threshold was associated with a 28% reduction in fracture risk compared with less-persistent women. CONCLUSIONS In this study, better treatment adherence was associated with a greater reduction in fracture risk. Compliance appeared to predict fracture risk better than did persistence.

Prevalence and features of osteoporosis in the French general population: the Instant study.

OBJECTIVES To determine the prevalence of diagnosed osteoporosis, the extent of treatment use and the incidence of fracture in a representative sample of the French general population. METHODS A cross-sectional epidemiological survey of osteoporosis in 2613 women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on the diagnosis of osteoporosis, fracture history, treatments, clinical and sociodemographic variables. Variables potentially associated with fracture were evaluated using stepwise multivariate logistic regression analysis. RESULTS The overall prevalence of diagnosed osteoporosis was 9.7% [8.6%; 10.9%] and prevalence increased linearly with age. Overall, 155 women (61.0%) received osteoporosis treatment and treatment rates also increased with age. The most frequently prescribed treatments were bisphosphonates, in 50.3% of treated women. The treatment duration was over 2 years for 72.9% of treated women. Overall, 115 (45.3%) reported at least one previous fracture. Vertebral fractures were reported by 101 women (39.8%) and limb fractures by 41 women (16.1%). Multivariate logistic regression analysis identified fracture before the age of 40, menopause before the age of 40, use of sleeping pills, consultation with an eye specialist and history of cardiovascular disease as variables independently associated with fracture. CONCLUSIONS Osteoporosis in France appears to be under-diagnosed and under-treated. Awareness and management of risk factors for osteoporosis and fracture could thus be improved.

Calcium intake and the risk of osteoporosis and fractures in French women

OBJECTIVES To evaluate dietary calcium intake in postmenopausal women over 45 years of age and compare intake according to osteoporosis diagnosis and fracture history. METHODS A cross-sectional epidemiological survey of osteoporosis in postmenopausal women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on osteoporosis diagnosis, fracture history and risk factors. Information on dietary calcium intake was collected using a validated questionnaire. RESULTS Two thousand six hundred and thirty-one women (mean age: 67.9+/-10.0 years) were included. Two hundred and fifty-four (9.7%) had received a diagnosis of osteoporosis by bone densitometry, of whom 154 (45.3%) reported at least one previous fracture. Total mean daily dietary calcium intake was 754 mg/day, of which dairy products (milk, cheese and others) were the principal source. Overall, 37.2% of the sample consumed<600 mg/day and 20.1% >1000 mg/d. The proportion of women consuming <600 mg/day increased with age (p=0.0028). No difference in mean daily calcium intake was observed between women with or without a diagnosis of osteoporosis or with or without fractures. CONCLUSIONS Mean dietary calcium intake in this population is well below that recommended in current national guidelines (> or =1500 mg/day), notably in those most at risk for fractures, such as women with a diagnosis of osteoporosis or those in older age groups. Intake does not appear to be influenced by osteoporosis diagnosis or fracture experience.

Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment

BackgroundAdherence to anti-osteoporosis treatments is poor, exposing treated women to increased fracture risk. Determinants of poor adherence are poorly understood. The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance.MethodsThis was an observational, cross-sectional pharmacoepidemiological study with a randomly-selected sample of 420 GPs, 154 rheumatologists and 110 gynaecologists practicing in France. Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months. Investigators completed a questionnaire on clinical features, treatments and medical history, and on patient compliance. Patients completed a questionnaire on sociodemographic features, lifestyle, attitudes and knowledge about osteoporosis, treatment compliance, treatment satisfaction and quality of life. Treatment compliance was evaluated with the Morisky Medication-taking Adherence Scale. Variables collected in the questionnaires were evaluated for association with compliance using multivariate logistic regression analysis.Results785 women were evaluated. Physicians considered 95.4% of the sample to be compliant, but only 65.5% of women considered themselves compliant. The correlation between patient and physician perceptions of compliance was low (κ: 0.11 [95% CI: 0.06 to 0.16]). Patient-rated compliance was highest for monthly bisphosphonates (79.7%) and lowest for hormone substitution therapy (50.0%). Six variables were associated with compliance: treatment administration frequency, perceptions of long-term treatment acceptability, perceptions of health consequences of osteoporosis, perceptions of knowledge about osteoporosis, exercise and mental quality of life.ConclusionCompliance to anti-osteoporosis treatments is poor. Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance.

Prostate-specific antigen flare induced by cabazitaxel-based chemotherapy in patients with metastatic castration-resistant prostate cancer

BACKGROUND A prostate-specific antigen (PSA) flare occurs in about 15% of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel. This flare has no standard definition. Its impact on treatment efficacy is unclear. We sought to evaluate the incidence and characteristics of PSA flare on cabazitaxel, and its impact on survival. METHODS Multicentre retrospective review of consecutive patients treated with cabazitaxel second-line chemotherapy for mCRPC. Collection of baseline characteristics, disease history and PSA levels before and during cabazitaxel therapy. Overall survival (OS) and radiological/clinical progression-free survival (PFS) for patient groups corresponding to different definitions of PSA flare estimated by the Kaplan-Meier method and compared using the log-rank test. RESULTS Overall, 125 patients were included. Median PFS and OS were 6.5 and 13.3 months, respectively. Depending upon the definition used, flare incidence ranged from 8.3% to 30.6%. The flare lasted <2.6 months. A PSA flare followed by a ⩾ 50% decrease was associated with a median PFS and OS of 11.2 and 25.2 months, respectively. Median PFS and OS for a ⩾ 30% rather than ⩾ 5 0% decrease were 10.4 and 16.5 months. These outcomes were not significantly different from those in patients with immediate PSA decreases of ⩾ 50% or ⩾ 30% from baseline, but were significantly better than in patients experiencing no PSA decrease (p = 0.006 and 0.015, respectively, for OS). CONCLUSION The PSA response to cabazitaxel, with or without initial flare, was associated with a strong survival benefit. The taxane-induced flare during the first 12 weeks of therapy can be ignored when evaluating PSA response.

Prevalence of risk factors for referring post-menopausal women for bone densitometry. The INSTANT study.

BACKGROUND Measurement of bone density by densitometry is an appropriate public health strategy for prevention of osteoporotic fractures in at-risk individuals, and physicians are encouraged to screen for these risk factors in post-menopausal women. OBJECTIVE To determine the frequency of risk factors for osteoporosis in a representative sample of the French general population in order to estimate the number of women eligible for bone densitometry. METHODS A cross-sectional epidemiological survey of osteoporosis in 2081 post-menopausal women over 45 years in the general population was conducted using a stratified random sampling method and face-to-face interviews. Information was collected on personal or family history of vertebral fracture or limb fracture, endocrine disorders, corticosteroid use, and early menopause. Body mass index was determined during the interview by measuring height and weight. RESULTS A total of 1041 women interviewed (51.8%) reported at least one risk factor for osteoporosis and would thus be eligible for densitometry. The most frequently reported risk factor was vertebral fracture or collapse (20.8%), followed by endocrine disorders (10.5%) and long-term corticosteroid treatment (10.5%). The prevalence of vertebral and limb fracture increased with age. Multiple risk factors were reported by 381 women and the proportion of women presenting multiple risk factors increased with age. CONCLUSIONS Extrapolated to the general population, over five million women in France would be eligible for densitometry. Since only a small proportion of these currently receive a diagnosis of osteoporosis, a considerable number of women could thus potentially benefit from more widespread use of densitometry.

Management of osteoporosis and associated quality of life in post menopausal women

BackgroundThe study aimed to describe the characteristics of women treated for recently-diagnosed osteoporosis, to identify variables associated with different treatment regimens and to assess impact on quality of life.MethodsThis is an observational, cross-sectional pharmacoepidemiological study performed in France. A random sample of 684 general practitioners, gynaecologists and rheumatologists included the first three post-menopausal osteoporotic women consulting in the previous six months on the basis of densitometry or fracture. Data on osteoporosis, fracture risk factors, treatments and comorbidities was collected with a physician questionnaire. Data on quality of life was collected using the SF-12.ResultsData were analysed for 1,306 patients, of whom 1,117 (85.5%) had been evaluated by densitometry within the previous six months and 554 (42.4%) had experienced a fracture, most frequently of the spine or wrist within the previous six months. Osteoporotic fracture risk factors were reported in 1,028 women (78.7%). 746 women (57.1%) were currently receiving treatment, most frequently weekly or monthly bisphosphonates. Five variables were associated with prescription choice: age (p < 0.0001), physician speciality (p < 0.0001), previous fracture history (p = 0.0002), ongoing treatment at the time of consultation (p = 0.0091) and paraclinical investigations performed in the previous six months (p = 0.0060). SF-12 scores were lower in women complaining of pain, with recent fractures and with spine or hip fractures and in women consulting rheumatologists.ConclusionsA high proportion of women diagnosed with osteoporosis had been evaluated by densitometry, in agreement with national guidelines. Treatment choice varied between physician groups.

Safety and efficacy of 2-weekly cabazitaxel in metastatic castration-resistant prostate cancer

To evaluate the safety and efficacy of a 2‐weekly cabazitaxel schedule in patients with metastatic castration‐resistant prostate cancer (mCRPC).