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Persistence of Denosumab Terapy among Patients with Osteoporosis

Kobayash K1, Ando K1, Machino M1, Morozumi M1, Kanbara S1, Ito S1, Inoue T1, Yamaguchi H1, Ishiguro N1, Imagama S1.

Asian Spine J. 2020 Jan 17. doi: 10.31616/asj.2019.0230. [Epub ahead of print]

Abstract
STUDY DESIGN:
Retrospective study in a single center.

PURPOSE:
To examine denosumab persistence in patients of different ages with severe osteoporosis in Japan.

OVERVIEW OF LITERATURE:
Denosumab is an antibody drug used for the treatment of osteoporosis. It is mainly used in patients with severe osteoporosis who might have high motivation for treatment, and the need for only semi-annual subcutaneous injection might improve the continuation rate. However, no English-language articles have reported on denosumab persistence in the Japanese population, including young people, despite the importance of this issue in a super-aging society.

METHODS:
The subjects started treatment with subcutaneous denosumab in our department from July 2013 until December 2017. Persistence rates were calculated using Kaplan-Meier curves. Patients were defined as «persistent» or «non-persistent» according to the use of therapy after 60 months.

RESULTS:
The study included 101 patients (84 females) with a median follow-up period of 23.6±14.2 months. The persistence rate declined to 85.3%, 78.3%, 74.1%, 71.3%, and 69.3% at 12, 24, 36, 48, and 60 months, respectively. Age at the initiation of denosumab therapy differed significantly between non-persistent (n=31) and persistent (n=70) patients (81.3 vs. 72.8 years, p <0.01). Persistence was significantly lower in patients aged ≥80 years than in those aged <60 and 60-79 years (both p <0.01). The reasons for non-persistence of denosumab therapy were transfer to another hospital (n=13), interruption of outpatient visits (n=11), dental treatment (n=4), adverse events (n=2), and patient request (n=1). CONCLUSIONS: Persistence was significantly lower in patients aged ≥80 years than in patients of other ages, and strategies promoting persistence are needed for these elderly patients.