Adherence, patient preference and dosing frequency: Understanding the relationship
Introduction
Poor therapeutic adherence among patients suffering from chronic asymptomatic disease is a major issue facing physicians today [1]. Up to 50% of patients with chronic disease, such as hypertension, depression and asthma discontinue medication, with the rate rising in different therapeutic areas (up to 70% of patients prescribed preventive asthma medication stop treatment) and different countries (51% of patients in the USA continue with antihypertensives compared with 26% in the Seychelles). Poor adherence is considered to be ‘the primary reason for suboptimal clinical benefit’ of therapy [1]. Since the primary objective of treatment is not met, patients may experience complications. Furthermore, patients may experience reduced quality of life, which, in turn, leads to greater healthcare costs. Therefore, addressing poor adherence could potentially benefit both patients and society [1].
Section snippets
Therapeutic adherence
In general terms, adherence is ‘the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a health care provider’ [1]. Therapeutic adherence is a summary term determined by persistence and compliance of medication intake. Persistence describes the length of time a patient continues taking medication and is measured as the time from treatment initiation to treatment completion or discontinuation.
Adherence with therapy for the treatment of osteoporosis
Osteoporosis is a chronic, asymptomatic condition characterized by low bone mass and an increased fragility for fracture [3]. Patients often experience few clinical symptoms prior to fracture and do not perceive the need for treatment [4]. Data from a study evaluating adherence to bisphosphonate therapy show that the probability of continuing daily oral treatment is approximately 50% at 1 year [5]. Even when diagnosed, patients may not perceive any direct benefit from taking medication as they
Impact of poor adherence with bisphosphonates on treatment outcomes
Suboptimal therapeutic adherence with oral bisphosphonates negatively impacts upon treatment outcomes. Compliance with risedronate and its influence on biochemical markers of bone turnover was assessed in a sub-analysis of patients from the IMPACT database (n = 2302) [20]. After 22 weeks of treatment, approximately 60% of compliant patients had a >50% decrease from baseline in serum C-telopeptide of the α-chain of type I collagen, compared with 20% of non-compliant patients. A second study
Can reducing dosing frequency improve therapeutic adherence?
Since it is important for patients receiving bisphosphonates to remain on treatment in order to obtain maximum clinical benefit, any factors that could increase adherence are worthy of investigation. A report from the Surgeon General raises the question as to whether the currently available doses and schedules of osteoporosis medication are the most effective for encouraging adherence and therefore reducing fractures in the ‘real-world’ setting [23]. The report also asks whether increasing the
Influence of patient preference on therapeutic adherence
Patient's preferences for daily or weekly bisphosphonate therapy have been evaluated in a prospective, open-label studies [27], [28]. Four hundred and six postmenopausal women with osteoporosis were randomized to receive daily and weekly alendronate for 4 weeks per regimen using a crossover design. A total of 396 participants received both regimens and completed a preference questionnaire. Of the 364 (92%) women who expressed a preference, a significant number of patients (over 80%) expressed a
Discussion
Poor adherence is a common cause of reduced patient benefit from therapies used in the ‘real-world’ setting compared with the benefits demonstrated in clinical trials. Inadequate therapeutic adherence to oral bisphosphonates in the treatment of osteoporosis compromises therapeutic outcomes, resulting in lower BMD gains, reduced effects on bone turnover and subsequently a lower antifracture effect. It has been shown that improving compliance and persistence enhances patient outcomes. Therefore,
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