1
|
Kunimoto Y, Matamura R, Ikeda H, Horiguchi H, Fujii S, Kobune M, Fukudo M, Toda T. Adherence of denosumab treatment for low bone mineral density in Japanese people living with HIV: a retrospective observational study. J Pharm Health Care Sci 2023; 9:45. [PMID: 38057906 DOI: 10.1186/s40780-023-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Long-term care issues, specifically metabolic bone disorders, are a concern for people living with human immunodeficiency virus (PLWH) who undergo life-long antiretroviral therapy (ART). Previous clinical trials with denosumab, an anti-RANKL antibody inhibitor, have revealed its effectiveness in increasing bone mineral density (BMD) in patients with osteoporosis. However, there are limited data on adherence and effectiveness of denosumab treatment for osteoporosis in PLWH. Hence, this study aimed to investigate the adherence and effectiveness of denosumab treatment for osteoporosis in Japanese PLWH. METHODS This study is a retrospective exploratory analysis of 29 Japanese PLWH who initiated denosumab treatment for osteoporosis, between 2013 and 2021. The study included patients who received at least one dose of denosumab every 6 months. Adherence and persistence were defined as receiving two consecutive injections of denosumab 6 months ± 4 weeks apart and 6 months + 8 weeks apart, respectively. The primary outcome measure of the study was the adherence of denosumab treatment for 24 months. The secondary outcome measures included treatment persistence and BMD. The period after January 2020 was defined as the coronavirus disease 2019 (COVID-19) pandemic period, and its impact on adherence was investigated. RESULTS The treatment adherence rates at 12 and 24 months were 89.7% and 60.7%, respectively. By contrast, the treatment persistence at 12 and 24 months was 100% and 85.7%, respectively. More patients in the group who initiated denosumab treatment after the COVID-19 pandemic reached non-adherence than in the group who initiated denosumab treatment before the pandemic. BMD at the lumbar spine and femoral neck significantly increased compared to that at baseline, with median percentage changes of 8.7% (p < 0.001) and 3.5% (p = 0.001), respectively. CONCLUSIONS The results showed that patients in the study had a high rate of non-adherence but a lower rate of non-persistence. Additionally, PLWH on ongoing ART experienced increased BMD with denosumab treatment. This study provides an opportunity to improve future strategies for denosumab treatment in the Japanese PLWH.
Collapse
Affiliation(s)
- Yusuke Kunimoto
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Ryosuke Matamura
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroto Horiguchi
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan
| | - Masayoshi Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo, 060-8543, Japan.
| | - Takaki Toda
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo, Japan
| |
Collapse
|
2
|
Cruchelow KR, Peter ME, Chakrabarti A, Gipson HM, Gregory WT, DeClercq J, Choi L, Tanner SB. Denosumab treatment lapses, discontinuation, and off-treatment fracture risk: A retrospective study of patients with osteoporosis in a real-world clinical setting. Bone 2023; 177:116925. [PMID: 37797711 DOI: 10.1016/j.bone.2023.116925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The purpose of this study was to retrospectively examine predictors of fracture risk when adult patients experienced a denosumab treatment lapse or discontinuation in a real-world clinic setting. MATERIALS AND METHODS Eligible patients were adults who had received ≥2 doses of denosumab at an academic health center in the United States. Demographics, treatment doses, reasons for missed doses, and fractures, were collected retrospectively from electronic health records, from an 8-year period (2010-2018). The number of times each patient incurred a treatment lapse, defined as ≥240 days between two doses (excluding lapse due to discontinuation, death, or transfer of care) was computed. The occurrence of denosumab discontinuation (excluding discontinuation due to death or transfer of care), whether the patient initiated alternative therapy, and the reason for each lapse and discontinuation were collected. Cox proportional hazards models assessed characteristics associated with risk of fracture and treatment discontinuation. A logistic regression model was used to determine if cumulative amount of time off medication (i.e., cumulative lapse time) was associated with a higher likelihood of incurring a fracture. RESULTS We included 534 patients: 95 % White, 86 % women, 33 % tobacco users, 13 % diagnosed with diabetes, median age 69 years (Interquartile Range (IQR): 62-77), and median Body Mass Index (BMI) 25 kg/m2 (IQR: 22-28). Thirty-six percent of patients incurred 250 lapses; 10 % discontinued therapy. Dental problems/procedures and logistical barriers were the most common reasons for lapses and discontinuations. Nineteen percent (n = 103) incurred a total of 190 fractures; of these, 121 were osteoporotic, 50 were vertebral. Risk of any, osteoporotic, and vertebral fractures were associated with off-treatment status (hazard ratio [HR] = 1.7, p = 0.043; HR = 2.0, p = 0.026; and HR = 4.2, p = 0.001, respectively) and older age (HR = 1.3, p = 0.015; HR = 1.5, p = 0.001; and HR = 1.8, p = 0.005, respectively). Older age was associated with higher risk of discontinuation (HR = 1.4, p = 0.022). There was a non-significant trend of a nonlinear association between incurring a fracture and cumulative lapse time (p = 0.087). CONCLUSION Denosumab treatment lapses are common, and off-treatment status may be associated with a higher risk of fractures. Clinical teams should proactively identify and address adverse effects and potential logistical barriers to reduce the risk of treatment lapses.
Collapse
Affiliation(s)
- Katie R Cruchelow
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN, USA
| | - Megan E Peter
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN, USA
| | - Anwesa Chakrabarti
- Vanderbilt Specialty Pharmacy, Vanderbilt Health System, Nashville, TN, USA
| | - Hannah M Gipson
- The University of Tennessee Health Science Center, Nashville, TN, USA
| | - W Taylor Gregory
- The University of Tennessee Health Science Center, Nashville, TN, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Bobo Tanner
- Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
3
|
Pigni S, Mazziotti G. Gestione clinica della terapia con Denosumab: in chi, quando e come interromperla. L'ENDOCRINOLOGO 2023. [PMCID: PMC9906587 DOI: 10.1007/s40619-023-01207-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Denosumab (Dmab) è un potente farmaco anti-riassorbitivo impiegato per il trattamento dell’osteoporosi al dosaggio di 60 mg sottocute ogni sei 6 mesi. A differenza dei bisfosfonati (BPs), Dmab non si accumula nella matrice ossea e, in caso di ritardo o interruzione delle somministrazioni, è noto un effetto rebound sul turnover osseo, che si traduce in una rapida perdita di Bone Mineral Density (BMD) e in un aumento del rischio di fratture vertebrali, spesso cliniche e multiple. Data la rilevanza clinica di tale fenomeno, si rende quindi necessario per gli specialisti dedicati al trattamento delle patologie osteometaboliche conoscere nel dettaglio quali sono le evidenze attualmente disponibili, nonché le principali raccomandazioni relative alla gestione della terapia anti-osteoporotica con Dmab, con particolare attenzione alla sua interruzione (programmata o accidentale), su cui si focalizzerà la presente Rassegna.
Collapse
Affiliation(s)
- Stella Pigni
- grid.452490.eDipartimento di Scienze Biomediche, Humanitas University, Pieve Emanuele, MI Italia ,grid.417728.f0000 0004 1756 8807Unità di Endocrinologia, Diabetologia, Andrologia Medica; Centro di Ricerca, Diagnosi e Cura delle Malattie Osteometaboliche, Istituto Clinico Humanitas IRCCS, Rozzano, MI Italia
| | - Gherardo Mazziotti
- grid.452490.eDipartimento di Scienze Biomediche, Humanitas University, Pieve Emanuele, MI Italia ,grid.417728.f0000 0004 1756 8807Unità di Endocrinologia, Diabetologia, Andrologia Medica; Centro di Ricerca, Diagnosi e Cura delle Malattie Osteometaboliche, Istituto Clinico Humanitas IRCCS, Rozzano, MI Italia
| |
Collapse
|
4
|
Goulden EL, Crowley RK. When and how to stop denosumab therapy in a patient with osteoporosis. Clin Endocrinol (Oxf) 2022; 98:649-653. [PMID: 35470448 DOI: 10.1111/cen.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Denosumab is a human monoclonal antibody that competitively inhibits the receptor activator of nuclear factor kappa B ligand which regulates osteoclast activity. It is an effective treatment for osteoporosis with a reduced cumulative rate of vertebral fractures, hip and nonvertebral fractures as well as an increase in bone mineral density. The benefits have been shown to be maintained when treatment is continued up to and likely after 10 years of therapy, but the effects are lost rapidly if treatment is discontinued abruptly. There are rare medical indications for discontinuation of treatment. Discontinuation of denosumab is often driven by concern about complications such as osteonecrosis of the jaw, atypical femoral fractures and hypocalcaemia, which remain rare events. Further studies are required to confirm safety and efficacy beyond 10 years of treatment, but it is likely that patients will have ongoing benefits from therapy beyond this. We aim to present a personal perspective of why and how denosumab should be discontinued in patients with osteoporosis.
Collapse
Affiliation(s)
- Eirena L Goulden
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
| | - Rachel K Crowley
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
5
|
ROMANO F, DI BENEDETTO E, SCARANO E, RICCIO E, ARIANNA R, COLAO A, DI SOMMA C. Treatment of Paget's disease of the bone: long-term effect of neridronate in a real-life setting. Minerva Endocrinol (Torino) 2022; 46:374-383. [DOI: 10.23736/s2724-6507.20.03320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Osteoporosis Treatment with Anti-Sclerostin Antibodies-Mechanisms of Action and Clinical Application. J Clin Med 2021; 10:jcm10040787. [PMID: 33669283 PMCID: PMC7920044 DOI: 10.3390/jcm10040787] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/30/2021] [Accepted: 02/13/2021] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures and significant long-term disability. Although both anti-resorptive treatments and osteoanabolic drugs, such as parathyroid hormone analogues, are effective in fracture prevention, limitations exist due to lack of compliance or contraindications to these drugs. Thus, there is a need for novel potent therapies, especially for patients at high fracture risk. Romosozumab is a monoclonal antibody against sclerostin with a dual mode of action. It enhances bone formation and simultaneously suppresses bone resorption, resulting in a large anabolic window. In this opinion-based narrative review, we highlight the role of sclerostin as a critical regulator of bone mass and present human diseases of sclerostin deficiency as well as preclinical models of genetically modified sclerostin expression, which led to the development of anti-sclerostin antibodies. We review clinical studies of romosozumab in terms of bone mass accrual and anti-fracture activity in the setting of postmenopausal and male osteoporosis, present sequential treatment regimens, and discuss its safety profile and possible limitations in its use. Moreover, an outlook comprising future translational applications of anti-sclerostin antibodies in diseases other than osteoporosis is given, highlighting the clinical significance and future scopes of Wnt signaling in these settings.
Collapse
|
7
|
Monov S, Nestorova R, Velkova M, Boyanov M, Jeleva S, Petkova R, Petranova T. Persistence with Denosumab in Women at High Risk of Fracture in Bulgaria. Rheumatol Ther 2021; 8:443-455. [PMID: 33555564 PMCID: PMC7990988 DOI: 10.1007/s40744-021-00282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Post-menopausal women with osteoporosis > 70 years of age at high risk of fracture urgently require treatment for fracture prevention. Moreover, persistence with osteoporosis therapy is critical for real-world effectiveness. We estimated persistence with denosumab in older women at high fracture risk in clinical practice in Bulgaria. Methods Eligible participants were post-menopausal women, > 70 years of age, diagnosed with osteoporosis (T-score ≤ − 2.5) and at high risk of fracture (≥ 3% for hip and ≥ 20% for major osteoporotic fracture) who received at least one denosumab injection before enrollment. Planned follow-up was 24 months. The primary endpoint was persistence to denosumab at 12, 18, and 24 months (defined as receiving all denosumab injections within 6 months ± 60 days of the previous injection). Results 250 women were enrolled across 12 Bulgarian endocrinology/rheumatology practices; median follow up, 736 days. Mean (SD) age was 75.8 (4.2) years; mean (SD) FRAX® was 13.1 (8.6) for hip and 26.1 (9.5) for major osteoporotic fracture; 47 (18.8%) women had prior osteoporosis therapy and 104 (41.6%) had prior fracture. Denosumab persistence was high: 98.0%, 92.4%, and 84.4% at 12, 18, and 24 months, respectively. A total of 42 (16.8%) women discontinued denosumab during follow-up, mostly for financial reasons [25/42 (59.5%)] or loss to follow-up [8/42 (19.0%)]. After 24 months of denosumab treatment, BMD T-score improvement to the range of osteopenia (− 2.5 ≤ T < − 1.5) was achieved by 42.4% at the femoral neck, 23.6% at the lumbar spine, and 49.2% at the total hip; complete recovery (T-score ≥ − 1.5) was observed in 9.0%, 26.4%, and 23.0% respectively. New fracture was reported in 5 patients (2%). Conclusions Even in an elderly population, persistence with denosumab was high despite the challenge imposed by the 50% co-pay in Bulgaria. Trial Registration Bulgarian Drug Agency, №HИП-0009 (registered 28.06.2017); Central Ethics Commission: №КИ-41 (registered 16.05.2017) Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00282-3.
Collapse
Affiliation(s)
- Simeon Monov
- Medical Center "Academy", Sofia, Bulgaria.,Clinic of Rheumatology, Medical University, Sofia, Bulgaria
| | | | | | | | | | | | - Tzvetanka Petranova
- Clinic of Rheumatology, UMHAT "St. Ivan Rilsky", Medical University, Sofia, Bulgaria
| |
Collapse
|
8
|
Mazziotti G, Betella N, Lania AG. Letter to the Editor: "Delayed Denosumab Injections and Bone Mineral Density Response: En Electronic Health Record-Based Study". J Clin Endocrinol Metab 2020; 105:5859156. [PMID: 32556183 DOI: 10.1210/clinem/dgaa384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Bone Diseases and Osteoporosis Section, Humanitas Clinical and Research Center, IRCSS, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nazarena Betella
- Endocrinology, Diabetology and Andrology Unit, Bone Diseases and Osteoporosis Section, Humanitas Clinical and Research Center, IRCSS, Rozzano (MI), Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea G Lania
- Endocrinology, Diabetology and Andrology Unit, Bone Diseases and Osteoporosis Section, Humanitas Clinical and Research Center, IRCSS, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|