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Byun DW, Moon SH, Kim T, Lee HH, Park HM, Kang MI, Ha YC, Chung HY, Yoon BK, Kim TY, Chae SU, Shin CS, Yang KH, Lee JH, Chang JS, Kim SH, Kim IJ, Koh JM, Jung JH, Yi KW, Yoo JJ, Chung DJ, Lee YK, Yoon HK, Hong S, Kim DY, Baek KH, Kim HJ, Kim YJ, Kang S, Min YK. Assessment of patient-reported outcomes (PROs): treatment satisfaction, medication adherence, and quality of life (QoL) and the associated factors in postmenopausal osteoporosis (PMO) patients in Korea. J Bone Miner Metab 2019; 37:563-572. [PMID: 30238428 DOI: 10.1007/s00774-018-0956-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 08/23/2018] [Indexed: 01/03/2023]
Abstract
Patient-reported outcomes (PROs) provide practical guides for treatment; however, studies that have evaluated PROs of women in Korea with postmenopausal osteoporosis (PMO) are lacking. This cross-sectional, multi-center (29 nationwide hospitals) study, performed from March 2013 to July 2014, aimed to assess PROs related to treatment satisfaction, medication adherence, and quality of life (QoL) in Korean PMO women using osteoporosis medication for prevention/treatment. Patient demographics, clinical characteristics, treatment patterns, PROs, and experience using medication were collected. The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) (score-range, 0-100; domains: effectiveness, side effects, convenience, global satisfaction), Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS) (score-range, 0-8), and EuroQol-5 dimensions questionnaire (index score range, - 0.22 to 1.0; EuroQol visual analog scale score range, 0-100) were used. To investigate factors associated with PROs, linear (treatment satisfaction/QoL) or logistic (medication adherence) regression analyses were conducted. A total of 1804 patients (age, 62 years) were investigated; 60.1% used bisphosphonate, with the majority (67.2%) using weekly medication, 27.8% used daily hormone replacement therapy, and 12.1% used daily selective estrogen receptor modulator. Several patients reported gastrointestinal (GI) events (31.6%) and dental visits due to problems (24.1%) while using medication. Factors associated with the highest OS-MMAS domain scores were convenience and global satisfaction. GI events were associated with non-adherence. TSQM scores for effectiveness, side effects, and GI risk factors were significantly associated with QoL. Our study elaborately assessed the factors associated with PROs of Korean PMO women. Based on our findings, appropriate treatment-related adjustments such as frequency/choice of medications and GI risk management may improve PROs.
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Affiliation(s)
- Dong Won Byun
- Department of Endocrinology, Internal Medicine, Soon Chun Hyang University Hospital, Seoul, South Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Hyoung Moo Park
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Seoul, South Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Ho-Yeon Chung
- Department of Endocrinology and Metabolism, Kyung Hee University, School of Medicine, Seoul, South Korea
| | - Byung-Koo Yoon
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Tae-Young Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Soo Uk Chae
- Department of Orthopedic Surgery, Gunsan Medical Center of Wonkwang University Hospital, Gunsan, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyu-Hyun Yang
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Hwa Jung
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dong Jin Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun-Koo Yoon
- Division of Endocrinology and Metabolism, Department of Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University, Seoul, South Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Deog-Yoon Kim
- Department of Nuclear Medicine, Kyung Hee University, School of Medicine, Seoul, South Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun-Joo Kim
- Pfizer Pharmaceuticals Korea Limited, Seoul, Republic of Korea
| | - Young-Joo Kim
- Pfizer Pharmaceuticals Korea Limited, Seoul, Republic of Korea
| | - Seongsik Kang
- Pfizer Pharmaceuticals Korea Limited, Seoul, Republic of Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Min J, Cohan S, Alvarez E, Sloane J, Phillips JT, van der Walt A, Koulinska I, Fang F, Miller C, Chan A. Real-World Characterization of Dimethyl Fumarate-Related Gastrointestinal Events in Multiple Sclerosis: Management Strategies to Improve Persistence on Treatment and Patient Outcomes. Neurol Ther 2019; 8:109-119. [PMID: 30706431 PMCID: PMC6534646 DOI: 10.1007/s40120-019-0127-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction Delayed-release dimethyl fumarate (DMF) is an effective treatment for multiple sclerosis (MS). Some patients experience gastrointestinal (GI) adverse events (AEs) that may lead to premature DMF discontinuation. This study characterized the impact of site-specific GI management strategies on the occurrence of GI events and discontinuation patterns. Methods Data on GI events and DMF persistence were retrospectively abstracted from medical records of patients treated with DMF in routine medical practice in the EFFECT study (NCT02776072). GI management strategies were assessed via a study site questionnaire. Discontinuation rates were analyzed according to counseling patterns. Results Of 826 DMF-treated patients at 66 sites, 809 from 65 sites were eligible for the GI analysis; of these, 27% experienced GI AEs. Within 1 year of treatment, 14% (118/826) of patients discontinued DMF, 5% (44/809) due to GI events. Most sites (92%) reported that patients were very likely (> 75% of the time) to be counseled about GI events at/before DMF treatment initiation and/or to be recommended that DMF be taken with food (86%); 48% of sites reported to be very likely to recommend using symptomatic therapies for GI AEs. Lower discontinuation rates were reported at sites very likely versus not very likely (≤ 75% of the time) to (1) provide counseling; (2) provide specific details regarding GI events; or (3) recommend taking DMF with food, and/or using symptomatic GI therapies. Conclusion Counseling and other GI management strategies at initiation of DMF treatment appear to reduce the burden of GI events, and a variety of GI management strategies may improve DMF persistence. Trial Registration NCT02776072. Funding Biogen (Cambridge, MA, USA). Electronic supplementary material The online version of this article (10.1007/s40120-019-0127-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence St Joseph Health, Portland, OR, USA
| | - Enrique Alvarez
- Rocky Mountain Multiple Sclerosis Center, University of Colorado, Aurora, CO, USA
| | - Jacob Sloane
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - J Theodore Phillips
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Anneke van der Walt
- Multiple Sclerosis Research Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | | | | | - Andrew Chan
- Department of Neurology, Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
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Modi A, Sen S, Adachi JD, Adami S, Cortet B, Cooper AL, Geusens P, Mellström D, Weaver JP, van den Bergh JP, Keown P, Sajjan S. The impact of GI events on persistence and adherence to osteoporosis treatment: 3-, 6-, and 12-month findings in the MUSIC-OS study. Osteoporos Int 2018; 29:329-337. [PMID: 29110061 PMCID: PMC5818582 DOI: 10.1007/s00198-017-4271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/12/2017] [Indexed: 01/22/2023]
Abstract
UNLABELLED The goal of this multinational, prospective, observational study was to examine the relationship between gastrointestinal (GI) events and self-reported levels of medication adherence and persistence in postmenopausal women. A total of 73.9% of patients remained on their osteoporosis (OP) therapy at month 12, although the presence of a GI event at baseline, month 3, and month 6 significantly reduced month 12 persistence among new users. The odds of a month-12 ADEOS score ≥ 20 were significantly lower among patients who experienced a GI event between baseline and month 6. The occurrence of GI events was observed to be associated with a lower likelihood of patient adherence and persistence to OP medication. INTRODUCTION This study examines the relationship between gastrointestinal (GI) events and self-reported adherence and persistence with initial osteoporosis (OP) therapy over the course of the first 12 months of treatment. METHODS The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study was a multinational, prospective, observational study examining the impact of GI events on OP management in postmenopausal women. Information regarding GI events was collected at the time of enrollment and at months 3, 6, and 12 of follow-up. Patients reported GI events and medication persistence and completed the 12-item Adherence Evaluation of Osteoporosis treatment (ADEOS) questionnaire. Multivariate logistic and general linear models examined the association between GI events at various time points and persistence and adherence at month 12. RESULTS The study enrolled 2943 women; 22.8% were classified as new users of OP therapy and the remainder were considered experienced users. Across all patients, 68.1% reported GI events at baseline; by month 12, over 80% of subjects who completed follow-up reported at least one GI problem. The majority of patients (86.7%) were treated only with bisphosphonates at baseline. At month 12, 73.9% of patients remained on therapy; logistic regression revealed that those with GI problems by month 6 were significantly less likely to persist with treatment, after adjusting for other factors. The odds of a month 12 ADEOS score ≥ 20 (considered predictive of adherence) were significantly lower among patients who experienced a GI event between baseline and month 6. CONCLUSIONS The occurrence of GI events was associated with a lower likelihood of patient adherence to and persistence with OP medication.
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Affiliation(s)
- A Modi
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA.
| | - S Sen
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA
| | - J D Adachi
- St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada
| | - S Adami
- Department of Medicine, University of Verona, Verona, Italy
| | - B Cortet
- Department of Rheumatology, University Hospital of Lille, Lille Cedex, France
| | - A L Cooper
- Bridge Medical Center, Crawley, West Sussex, UK
| | - P Geusens
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D Mellström
- Department of Internal Medicine and Geriatrics, Gothenburg University, Gothenburg, Sweden
| | - J P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA
| | - J P van den Bergh
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - P Keown
- Syreon Corporation, Vancouver, Canada
| | - S Sajjan
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA
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