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Adherence and Persistence to Teriparatide Treatment

Background

Osteoporosis increases the risk of fracture and associated morbidity and mortality. Efficacy of anti-osteoporotic treatment is based on drug potency and adherence and persistence. Teriparatide (TPTD) is the first anabolic agent developed for the treatment of osteoporosis and can significantly reduce the incidence of vertebral fractures. We evaluated adherence and persistence to TPTD treatment in patients with severe osteoporosis in a specialised Bone Health Service.

Methods

A cross-sectional and retrospective longitudinal study was performed of all patients in our clinic with severe osteoporosis treated with TPTD from 2004 to 2016.

Results

597 patients commenced TPTD from 2004 to 2016: 90% female, mean age 70 years (range 30–99); 225 (38%) had vertebral fractures; 136 (23%) had Colles fractures; and 75 (13%) had a hip fracture. 106 patients (18%) are currently on treatment. 491 (82%) are no longer on treatment with 367 (75%) having completed 18 months or more of treatment. 122 patients (25%) stopped treatment before 18 months. Of these, the mean length of time on treatment was 195 days. Reasons for prematurely stopping included self-discontinued 19 (16%), side effects 62 (51%), death from any cause 8 (7%), incidental cancer diagnosis 4 (3%), lost to follow up 8 (7%) and other 21 (17%). Most side effects experienced were mild and included rash 4 (6%), palpitations 4 (6%), headaches 6 (10%), fatigue 7 (11%), nausea 11 (18%), dizziness 12 (19%) and generalised/joint pain 29 (47%). However a small number reported night sweats 1 (2%), UTI/kidney stones 3 (5%) and weight loss 1 (2%).

Conclusion

In our study adherence and persistence with TPTD was higher than that reported with oral antiresorptive treatments. The major factor that reduced adherence and persistence was tolerability. These findings are important, as high adherence and persistence with therapy is necessary to ensure an optimal therapeutic outcome.