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Gupta N, Swindells S, Scarsi KK, Furl R, Thomas DL, Weld ED, Ofimboudem JD, Desalegn H, Hamid S, Rosas ADLT, Miranda AE, Owen A, Rannard S, Hiebert L, Sun K, Ward JW. Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers. J Viral Hepat 2024; 31:221-232. [PMID: 38545826 DOI: 10.1111/jvh.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 04/18/2024]
Abstract
Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs.
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Affiliation(s)
- Neil Gupta
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Susan Swindells
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Renae Furl
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David L Thomas
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethel D Weld
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Clinical Pharmacology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Saeed Hamid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Angelica E Miranda
- Post-Graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Katherine Sun
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
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Kim JW, Jung JY, Kim HA, Son H, Suh CH. Patient preference, efficacy, and compliance with zoledronic acid for glucocorticoid-induced osteoporosis in patients with autoimmune diseases. Postgrad Med J 2024; 100:334-341. [PMID: 38297995 DOI: 10.1093/postmj/qgae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/06/2023] [Accepted: 12/25/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE We evaluated the preference, patient satisfaction, and efficacy of zoledronic acid compared with oral bisphosphonates (BPs) for glucocorticoid-induced osteoporosis (GIOP) in patients with autoimmune diseases. METHODS We enrolled 50 patients with new fractures or osteoporosis detected on follow-up bone densitometry after at least 1 year of oral BP use among patients diagnosed with GIOP during treatment for autoimmune diseases. After 1 year of zoledronic acid treatment, patients completed a survey for preference and satisfaction assessment. Treatment efficacy was analysed by comparing bone mineral density changes and fractures with those in a control group of patients who continued oral BP use. RESULTS Age, sex, treatment duration, and medication history did not differ significantly between the two groups. Among the participants, 86.7% preferred and were more satisfied with intravenous zoledronic acid than with oral BPs, primarily because of the convenience of its administration interval. Only two patients (4%) reported infusion-related adverse events with zoledronic acid. Furthermore, no significant differences were observed in the annualized percentage change in the bone mineral density of the lumbar spine, femur neck, and hip between patients receiving zoledronic acid and those receiving oral BPs. The occurrence of new fractures was consistent across both groups, with two cases in each, showing no significant differences. CONCLUSION Patients showed a preference for and greater satisfaction with zoledronic acid, and its efficacy in treating osteoporosis was comparable to that of oral BPs. Therefore, zoledronic acid is a suitable treatment option for GIOP in patients with autoimmune diseases.
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Affiliation(s)
- Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Heejun Son
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
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Zheng X, Ye J, Zhan Q, Zhao W, Liao Z, Ye X, Qu C. Prediction of musculoskeletal pain after the first intravenous zoledronic acid injection in patients with primary osteoporosis: development and evaluation of a new nomogram. BMC Musculoskelet Disord 2023; 24:841. [PMID: 37880626 PMCID: PMC10598955 DOI: 10.1186/s12891-023-06965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To construct a new prediction nomogram to predict the risk of musculoskeletal pain in patients with primary osteoporosis who receive zoledronic acid intravenously for the first time. METHOD Clinical data of 368 patients with primary osteoporosis who received the first intravenous injection of zoledronic acid in our hospital from December 2019 to December 2022 were studied. Patients were divided into a musculoskeletal pain group (n = 258) and a non-musculoskeletal pain group (n = 110) based on the presence or absence of musculoskeletal pain 3 days after injection. Statistically significant predictors were screened by logistic regression analysis and the minimum absolute contraction and selection operator (LASSO) to construct a nomogram. The nomogram was evaluated by the receiver operating characteristic (ROC) curve, the calibration curve, the C-index, and the decision curve analysis (DCA) and verified in a validation cohort. RESULTS The independent predictors of the nomogram were age, serum 25-hydroxyvitamin D, NSAIDs, prior Vitamin D intake, and BMI. The area under the ROC curve (AUC) was 0.980 (95% CI, 0.915-0.987), showing excellent predictive performance. The nomogram c index was 0.980, and the nomogram c index for internal verification remained high at 0.979. Moreover, calibration curves show that the nomogram has good consistency. Finally, the DCA showed that the net benefit of the nomogram was 0.20-0.49. CONCLUSION Musculoskeletal pain is a common symptom of APR in OP patients treated with intravenous zoledronic acid. Risk factors for musculoskeletal pain after zoledronic acid injection in OP patients were: non-use of NSAIDs, youth (<80 years old), serum 25 (OH) D<30ng /mL, no prior intake of vitamin D, BMI<24 kg /m2. A nomogram constructed from the above predictors can be used to predict musculoskeletal pain after the first zoledronic acid injection.
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Affiliation(s)
- Xiaoxia Zheng
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiangnan Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qunzhang Zhan
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weifeng Zhao
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No.261, Longxi Avenue, Guangzhou, 510000, Guangdong, China
| | - Zhongqin Liao
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaolin Ye
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chongzheng Qu
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
- The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No.261, Longxi Avenue, Guangzhou, 510000, Guangdong, China.
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Tsai YL, Wu CH, Li CC, Shih CA, Chang YF, Hwang JS, Tai TW. Drug adherence and treatment duration for denosumab and mortality risk among hip fracture patients. Osteoporos Int 2023; 34:1783-1791. [PMID: 37466659 DOI: 10.1007/s00198-023-06845-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Abstract
This study aimed to assess the impact of drug adherence and treatment duration for denosumab on mortality risk after hip fracture surgery. Lower all-cause mortality risk was associated with drug intervals of 7 months or less and longer treatment duration. The study highlights the importance of proper denosumab administration. PURPOSE Prescription of anti-osteoporotic medications (AOMs) after osteoporotic hip fracture may increase bone mineral density (BMD) and decrease mortality risk. However, few studies have been conducted on drug adherence and treatment duration for denosumab, a popular choice among AOMs. This study aimed to assess the impact of denosumab adherence and treatment duration on the mortality risk of hip fracture patients after surgery. METHODS We conducted a cohort study using nationwide population data from National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with osteoporosis and hip fracture between 2008 and 2019 who used denosumab after surgery were included. We assessed drug adherence, treatment duration, and other parameters associated with patient outcomes. RESULTS A total of 21,316 patients diagnosed with osteoporotic hip fractures were included. Compared with a > 7-month drug interval for denosumab, an interval of ≤ 7 months led to lower all-cause mortality risk (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.57 ~ 0.64). Patients with denosumab treatment for over 1, 2, and 3 years had lower all-cause mortality risk (HR&CI: 0.68 (0.64 ~ 0.73), 0.48 (0.43 ~ 0.53), 0.29 (0.26 ~ 0.33)) than those with treatment duration < 1 year. Analysis after excluding short-term death yielded similar results. Analysis of causes of death also showed that good adherence and longer duration were associated with reduced mortality due to cancer and cardiovascular disease. CONCLUSION Better drug adherence and longer duration of denosumab treatment are associated with lower all-cause mortality risk among hip fracture patients after surgery. Our study highlights the benefits of a proper time interval of denosumab administration. These findings provide important insight into management of osteoporotic hip fractures and may inform clinical practice and development of guidelines.
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Affiliation(s)
- Yi-Lun Tsai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Murdoch R, Mellar A, Horne AM, Billington E, Chan PL, Gamble GD, Reid IR. Effect of a Three-Day Course of Dexamethasone on Acute Phase Response Following Treatment With Zoledronate: A Randomized Controlled Trial. J Bone Miner Res 2023; 38:631-638. [PMID: 36970850 DOI: 10.1002/jbmr.4802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 04/11/2023]
Abstract
Zoledronate is a potent intravenous bisphosphonate effective in the management of osteoporosis, Paget's disease and skeletal-related events in malignancy. Its most frequent adverse effect is the acute phase response (APR), an inflammatory reaction characterized by fever, musculoskeletal pain, headache, and nausea. This randomized, placebo-controlled, double-blind study investigated the efficacy of a three-day course of dexamethasone 4 mg daily in reducing incidence of APR. Participants (n = 60) were randomized to receive either 4 mg of oral dexamethasone 1.5 hours before zoledronate and once a day for the following 2 days, or placebo. Oral temperature was measured at baseline and three times a day for the following 3 days, and questionnaires assessing symptoms of the APR were completed at baseline and for 3 days following zoledronate. Use of anti-inflammatory medication in the 3 days following zoledronate was recorded. The primary outcome was the temperature change from baseline. There was a significant difference in the primary outcome between the dexamethasone and placebo groups (p < 0.0001), with a mean decrease in temperature of 0.10°C (95% confidence interval [CI], -0.34 to 0.14) in the dexamethasone group compared with a mean increase in temperature of 0.84°C (95% CI, 0.53-1.16) in the placebo group on the evening following zoledronate. There was also a difference in APR-related symptom score over time between the two groups (p = 0.0005), with a median change in symptom score in the dexamethasone group 1 day after zoledronate of 0 (95% CI, 0-1) compared with 3 (95% CI, 0-5) in the placebo group. An increase in temperature of ≥1°C to a temperature of >37.5°C occurred in two of 30 (6.7%) participants in the dexamethasone group compared with 14 of 30 participants (46.7%) in the placebo group (p = 0.0005). This study demonstrates that a 3-day course of dexamethasone substantially reduces the APR following zoledronate infusion. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Rachel Murdoch
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Mellar
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anne M Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Emma Billington
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Pui Ling Chan
- Department of Endocrinology, Middlemore Hospital, Auckland, New Zealand
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Hjelholt TJ, Johnsen SP, Brynningsen PK, Andersen G, Pedersen AB. Impact of Stroke History on the Risk of Recurrent Hip Fracture or Major Osteoporotic Fractures among Patients with Incident Hip Fracture: A Nationwide Cohort Study. J Bone Miner Res 2023; 38:278-287. [PMID: 36533810 PMCID: PMC10107617 DOI: 10.1002/jbmr.4760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/21/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Considerable uncertainty prevails regarding risk factors for recurrent fracture among older patients with hip fracture. We aimed to investigate the relationship between prefracture stroke history, baseline mobility, and the risk of recurrent hip fracture. This cohort study was based on the Danish Multidisciplinary Hip Fracture Registry, 2011-2018 (n = 48,230). We estimated cumulative incidence (competing risk of death) of recurrent hip fracture and major osteoporotic fractures within 1 and 2 years comparing patients with/without prefracture stroke history. Analyses were performed overall and stratified on baseline mobility status (good mobility: Cumulated Ambulation Score ≥ 5 versus poor mobility: Cumulated Ambulation Score < 5). Using Cox regression, adjusted cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) were obtained. The 1-year cumulative incidence was 4.6% (95% CI: 3.9-5.4) among patients with stroke history and 4.3% (95% CI: 4.1-4.5) among patients without stroke history. For patients with good mobility, the cumulative incidence of recurrent hip fracture was 5.8% (95% CI: 4.3-7.5) versus 3.7% (95% CI: 3.4-4.0) for patients with versus without stroke history. Corresponding numbers for patients with poor mobility were 4.4% (95% CI: 3.6-5.5) and 5.0% (95% CI: 4.7-5.3). Stroke history was associated with an adjusted HR of 1.55 (95% CI: 1.15-2.10) for recurrent fracture among patients with good mobility. In contrast, no association was observed among patients with poor mobility (adjusted HR 0.88 [95% CI: 0.70-1.10]). The associations were attenuated after 2 years of follow-up and for major osteoporotic fractures. In conclusion, stroke history was associated with slightly higher risk of recurrent fracture among patients with first-time hip fracture in the overall analysis, although the CI included a null result. The association was modified by baseline mobility: Patients with stroke history and good mobility had a markedly higher risk, whereas patients with stroke and poor mobility did not. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thomas J Hjelholt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.,Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg Ø, Denmark
| | | | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
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Kim SJ, Kim JW, Lee DW. Denosumab versus zoledronic acid in elderly patients after hip fracture. J Orthop Surg (Hong Kong) 2022; 30:10225536221147082. [PMID: 36541833 DOI: 10.1177/10225536221147082] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two injectable anti-osteoporosis medications, denosumab and zoledronic acid, have been widely used to treat patients with severe osteoporosis. The purpose of this study was to evaluate the real-world effectiveness and adherence of denosumab compared to zoledronic acid in geriatric patients after a hip fracture. METHODS A total of 282 patients treated with osteoporotic hip fracture between March 2014 and Aug 2022 were retrospectively reviewed. The patients were asked to select the anti-osteoporosis medication after surgery. Treatment persistence was monitored by follow-up visit to the outpatient clinic at postoperative 2 years. RESULTS Of 282 individuals with baseline data, 162 patients took subcutaneous denosumab and 120 patients took intravenous zoledronic acid. At postoperative 2 years, the change in bone mineral density (BMD) from baseline was greater in the denosumab group compared with the zoledronic acid group (p < 0.001). The rate of persistence to denosumab was significantly higher than that for 12-months zoledronic acid (p = 0.01). Serious adverse events were similar in the two groups. CONCLUSIONS Our study revealed the effectiveness and patients' persistence for two commonly used anti-osteoporosis agents after hip fracture. In this frail, elderly population, half-yearly denosumab was superior to yearly zoledronic acid in BMD and demonstrated significant higher persistence rate, indicating a potential therapeutic advantage that warrants further validation.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
| | - Ji Woon Kim
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, 371135Hanil General Hospital, Dobong-gu, Republic of Korea
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Flexner C, Thomas DL, Clayden P, Swindells S. What Clinicians Need to Know About the Development of Long-Acting Formulations. Clin Infect Dis 2022; 75:S487-S489. [PMID: 36410382 PMCID: PMC10200319 DOI: 10.1093/cid/ciac749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We encourage readers of this Supplement to find articles that are relevant to the current and future practice of infectious diseases medicine. Access to long-acting products and formulations in low- and middle-income countries remains a key determinant of the impact of these advances on global health.
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Affiliation(s)
- Charles Flexner
- Divisions of Clinical Pharmacology, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - David L Thomas
- Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Wang B, Zhan Y, Yan L, Hao D. How zoledronic acid improves osteoporosis by acting on osteoclasts. Front Pharmacol 2022; 13:961941. [PMID: 36091799 PMCID: PMC9452720 DOI: 10.3389/fphar.2022.961941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Osteoporosis is called a silent disease, because it is difficult to detect until comprehensive examinations for osteoporosis are performed or osteoporotic fractures occur. Zoledronic acid is currently the first-line anti-osteoporotic drug, with good efficacy and treatment compliance. A major advantage of zoledronic acid is that intravenous zoledronic acid often guarantees a therapeutic effect for up to 1 year after infusion. The reasons why zoledronic acid is effective in improving osteoporosis are that it can inhibit osteoclast differentiation and induce osteoclast apoptosis, thus suppressing bone resorption and increasing bone density. The story between zoledronic acid and osteoclasts has been written long time ago. Both the canonical receptor activator of the receptor activator of nuclear factor-κB ligand (RANKL) pathway and the non-canonical Wnt pathway are the main pathways by which zoledronic acid inhibits osteoclast differentiation. Farnesyl pyrophosphate synthase (FPPS), reactive oxygen species (ROS), and ferroptosis that was first proposed in 2012, are all considered to be closely associated with zoledronic acid-induced osteoclast apoptosis. Here, we provide a brief review of the recent progress on the study of zoledronic acid and osteoclasts, and hope to elaborate how zoledronic acid improves osteoporosis by acting on osteoclasts.
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Affiliation(s)
- Biao Wang
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
| | - Yi Zhan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- The Sceond Clinical Medical College of Shaanxi University of Chinese Medicine, Xi’an, China
| | - Liang Yan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
| | - Dingjun Hao
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
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Jia R, Liu N, Zhu Y, Li Q. Curative Effect of Prebiotics/Probiotics Preparations Combined with Zoledronic Acid + Calcitriol Regimen on Patients with Primary Osteoporosis and Their Influences on Bone Metabolism Markers. Emerg Med Int 2022; 2022:3293362. [PMID: 35912388 PMCID: PMC9334080 DOI: 10.1155/2022/3293362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the curative effect of prebiotics/probiotics preparations combined with zoledronic acid + calcitriol regimen on patients with primary osteoporosis (POP) and the influences of prebiotics/probiotics preparations combined with zoledronic acid + calcitriol regimen on markers of bone metabolism. Methods 126 elderly hospitalized patients with POP in our hospital from January 2020 to December 2021 were divided into the control group (n = 63) and the observation group (n = 63) by the random number table method. The patients in the control group were treated with zoledronic acid and calcitriol, while the patients in the observation group were additionally treated with prebiotics/probiotics preparations. The clinical curative effect, bone metabolism, calcium-phosphorus metabolism indexes, intestinal floras, and cytokines levels before and via treatment between the two groups were compared. Results The total efficiency of the observation group was higher than that of the control group (P < 0.05). After treatment, the levels of bone gla protein (BGP), total propeptide of type I procollagen (PINP), and β-crosslaps (β-CTX) in both groups were lower than those before treatment, and the levels of BGP, total PINP, and β-CTX in the observation group were lower than those in the control group (P < 0.05). The levels of serum P in the both groups after treatment were lower than those before treatment, and the level of serum P in the observation group was lower than that in the control group (P < 0.05). The number of Escherichia coli after treatment in the two groups were less than that before treatment, and the number of Escherichia coli in the observation group was less than that in the control group (P < 0.05). The number of bifidobacteria and lactobacilli in the two groups after treatment were more than that before treatment, and the number of bifidobacteria and lactobacilli in the observation group were more than those in the control group (P < 0.05). After treatment, the levels of IL-6 and TNF-α in the two groups were lower than those before treatment, and the levels of IL-6 and TNF-α in the observation group was lower than those in the control group (P < 0.05). The levels of IGF-1 in the two groups after treatment were higher than those before treatment, and the levels of IGF-1 in the observation group was higher than that in the control group (P < 0.05). Conclusion The response rate of prebiotics/probiotics preparations combined with zoledronic acid + calcitriol regimen is high in the treatment of POP patients, which ameliorates bone metabolism and intestinal floras, and suppresses cytokines release in patients with POP.
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Affiliation(s)
- Ruipeng Jia
- Department of Orthopaedic, Haikou People's Hospital, Haikou, Hainan 570208, China
| | - Ning Liu
- Department of Orthopaedic, The 942nd Hospital of the PLA Joint Logistic Support Force, Yinchuan, Ningxia 750004, China
| | - Yanyan Zhu
- Department of Clinical Pharmacy, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang 315000, China
| | - Qiaoli Li
- Department of Clinical Pharmacy, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang 315000, China
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Laurent MR, Goemaere S, Verroken C, Bergmann P, Body JJ, Bruyère O, Cavalier E, Rozenberg S, Lapauw B, Gielen E. Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club. Front Endocrinol (Lausanne) 2022; 13:908727. [PMID: 35757436 PMCID: PMC9219603 DOI: 10.3389/fendo.2022.908727] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids are effective immunomodulatory drugs used for many inflammatory disorders as well as in transplant recipients. However, both iatrogenic and endogenous glucocorticoid excess are also associated with several side effects including an increased risk of osteoporosis and fractures. Glucocorticoid-induced osteoporosis (GIOP) is a common secondary cause of osteoporosis in adults. Despite availability of clear evidence and international guidelines for the prevention of GIOP, a large treatment gap remains. In this narrative review, the Belgian Bone Club (BBC) updates its 2006 consensus recommendations for the prevention and treatment of GIOP in adults. The pathophysiology of GIOP is multifactorial. The BBC strongly advises non-pharmacological measures including physical exercise, smoking cessation and avoidance of alcohol abuse in all adults at risk for osteoporosis. Glucocorticoids are associated with impaired intestinal calcium absorption; the BBC therefore strongly recommend sufficient calcium intake and avoidance of vitamin D deficiency. We recommend assessment of fracture risk, taking age, sex, menopausal status, prior fractures, glucocorticoid dose, other clinical risk factors and bone mineral density into account. Placebo-controlled randomized controlled trials have demonstrated the efficacy of alendronate, risedronate, zoledronate, denosumab and teriparatide in GIOP. We suggest monitoring by dual-energy X-ray absorptiometry (DXA) and vertebral fracture identification one year after glucocorticoid initiation. The trabecular bone score might be considered during DXA monitoring. Extended femur scans might be considered at the time of DXA imaging in glucocorticoid users on long-term (≥ 3 years) antiresorptive therapy. Bone turnover markers may be considered for monitoring treatment with anti-resorptive or osteoanabolic drugs in GIOP. Although the pathophysiology of solid organ and hematopoietic stem cell transplantation-induced osteoporosis extends beyond GIOP alone, the BBC recommends similar evaluation, prevention, treatment and follow-up principles in these patients. Efforts to close the treatment gap in GIOP and implement available effective fracture prevention strategies into clinical practice in primary, secondary and tertiary care are urgently needed.
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Affiliation(s)
- Michaël R. Laurent
- Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Geriatrics, Imelda Hospital, Bonheiden, Belgium
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Verroken
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU de Liège, Liège, Belgium
| | - Serge Rozenberg
- Department of Gynaecology and Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
- Department of Endocrinology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Evelien Gielen
- Centre for Metabolic Bone Diseases, Department of Geriatrics, University Hospitals Leuven, Leuven, Belgium
- Gerontology and Geriatrics section, Department of Public Health and Primary Care, University Hospitals Leuven and KU Leuven, Leuven, Belgium
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12
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Park JW, Lee YK, Choi Y, Ha YC. Osteoporotic Fractures among Selective Estrogen Receptor Modulator Users in South Korea: Analysis Using National Claims Database. J Bone Metab 2022; 29:75-82. [PMID: 35718924 PMCID: PMC9208906 DOI: 10.11005/jbm.2022.29.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background We evaluated (1) compliance with selective estrogen receptor modulator (SERM) use in postmenopausal women; and (2) the risk of osteoporotic fractures according to compliance and other patient characteristics. Methods National claims data of postmenopausal women from January 2013 to December 2014 were reviewed. Demographics, comorbidities, type of medical institution, and patient compliance were investigated. Compliance was measured according to medication possession ratio (MPR) and the patients were classified into compliant (MPR ≥80%) or non-compliant (MPR <80%) groups. Osteoporotic fractures were followed up for 2 years after prescription. Results Among 15,166 postmenopausal women, 4,130 were categorized as compliant. Osteoporotic fractures were confirmed in 669 patients. The hip fracture rate in the non-compliant group (0.39%) was marginally higher than that in the compliant group (0.36%; P=0.06). Compared to age 50 to 54 years, age 55 to 59 years showed protection against fractures (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.379–0.857; P=0.007), while those over 70 years showed a higher risk of fractures (HR, 2.035; 95% CI, 1.485–2.789; P<0.0001 for age 70–74 years; HR, 2.197; 94% CI, 1.588–3.041; P<0.0001 for age 75–79 years; and HR, 3.53; 95% CI, 2.493–4.999; P<0.0001 for age ≥80 years). Patients with mild (HR, 1.29; 95% CI, 1.088–1.530; P=0.0034) and moderate (HR, 1.286; 95% CI, 1.002–1.652; P=0.0486) comorbidities were associated with higher risks of fractures compared to those without comorbidities. Conclusions Among postmenopausal women with osteoporosis, only 27.2% complied with SERM therapy. A marginal difference in hip fracture rate was observed between the compliant and non-compliant groups. Older age and severe comorbidities were associated with higher risks of osteoporotic fractures.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yangseon Choi
- Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea
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13
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Eyre TA, Jensen P, Booth S, El-Galaly TC. Bone health and glucocorticoid-containing lymphoma therapy - a review of risk factors and preventative measures. Br J Haematol 2022; 198:431-442. [PMID: 35235226 DOI: 10.1111/bjh.18104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/20/2023]
Abstract
With survival outcomes ever improving for patients with a wide range of lymphoma histologies, the focus on reducing long-term complications of therapy has increased. Recently published, complimentary population and retrospective series have highlighted the importance of considering bone health in patients treated for lymphoma. Fracture-related events or the requirement for secondary bone prophylaxis, likely linked to glucocorticoid-induced osteoporosis (GIO) are substantial and clinically meaningful in a significant minority of patients following routinely employed steroid-containing immunochemotherapy. In this review, we describe the pathophysiology of GIO, the risk of GIO in observational front-line lymphoma studies and efficacy of prophylactic measures from several prospective clinical trials are summarized. Finally, areas of importance for future research are discussed and recommendations for GIO risk assessment and management in lymphoma are provided based on the current available literature.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Haematology and Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paw Jensen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Stephen Booth
- Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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14
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Li C, Lu K, Shi Q, Gong YQ. Predicting the individualized risk of nonadherence to zoledronic acid among osteoporosis patients receiving the first infusion of zoledronic acid: development and validation of new predictive nomograms. Ther Adv Chronic Dis 2022; 13:20406223221114214. [PMID: 35924011 PMCID: PMC9340933 DOI: 10.1177/20406223221114214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Achieving optimal adherence to zoledronic acid (ZOL) among osteoporosis (OP) patients is a challenging task. Here, we aimed to develop and validate a precise and efficient prediction tool for ZOL nonadherence risk in OP patients. Methods: We prospectively collected and analyzed survey data from a clinical registry. A total of 1010 OP patients treated for the first time with ZOL in two separate hospitals were selected for nonadherence analysis. The evaluation included a 16-item ZOL Nonadherence Questionnaire and potential risk factors for ZOL nonadherence were assessed via univariate and multivariate analyses. We next developed and validated two distinct-stage nomograms. Discrimination, calibration, and clinical usefulness of the predicting models were assessed using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Results: The total nonadherence rate was 20.30% after the first ZOL infusion. To generate a model predicting ZOL nonadherence risk, six predictors of 16 items were retained. Model 2 (AUC, 0.8486; 95% confidence interval [CI], 0.8171–0.8801) exhibited considerably more discrimination in desirable functional outcomes, relative to Model 1 (AUC, 0.7644; 95% CI, 0.7265–0.8024). The calibration curves displayed good calibration. DCA revealed that a cutoff probability of 5–54% (Model 1) and 1–85% (Model 2) indicated that the models were clinically useful. External validation also exhibited good discrimination and calibration. Conclusions: This study developed and validated two novel, distinct-stage prediction nomograms that precisely estimate nonadherence risk among OP patients receiving the first infusion of ZOL. However, additional evaluation and external validation are necessary prior to widespread implementation.
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Affiliation(s)
- Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou 215300, China
- Department of Orthopedics, Gusu School, Nanjing Medical University, Suzhou, China
| | - Qin Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, China
| | - Ya-qin Gong
- Department of Information, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
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15
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Flores LE, Mack L, Wichman C, Weaver AA, Kothari V, Bilek LD. Protocol for a pilot randomised controlled trial of zoledronic acid to prevent bone loss following sleeve gastrectomy surgery. BMJ Open 2021; 11:e057483. [PMID: 34887285 PMCID: PMC8663101 DOI: 10.1136/bmjopen-2021-057483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an increasingly used and effective treatment for obesity; however, the rapid weight loss associated with SG adversely affects bone metabolism predisposing patients to skeletal fragility. Bisphosphonate medications have been evaluated for safety and efficacy in combating bone loss in patients with osteoporosis, but their use in SG-induced bone loss is limited. The goal of this study is to investigate how a one-time infusion of zoledronic acid compares to placebo, in its ability to combat SG-associated bone loss. METHODS AND ANALYSIS This research protocol is a 9-month, pilot randomized controlled trial (RCT) involving 30 adult SG patients randomised to receive an infusion of either 5 mg of zoledronic acid or placebo, 6 weeks following surgery. To be included participants must be <350 lbs/158.8 kg, free of bone-impacting pathologies or medications, and must have adequate serum calcium and vitamin D levels at baseline. The primary outcome is change in areal bone mineral density (aBMD) at the total hip. Secondary outcomes include change in aBMD of the femoral neck, and lumbar spine, and change in volumetric BMD at the lumbar spine. The primary aim will be tested using a linear mixed model fit with total hip aBMD at 9 months as the outcome. Treatment, participant sex and menopausal status will be considered in analysis. Groups will be compared using contrast statements at 9 months, with change over 9 months being the primary comparison. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the University of Nebraska Medical Center (IRB820-19). Written consent will be obtained from participants at enrolment by trained staff. Careful and thorough explanation are used in obtainment of consent and voluntariness is emphasised throughout the trial. The findings of this study will be presented locally, nationally, and published in peer-reviewed journals. Additional details will be reported on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04279392.
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Affiliation(s)
- Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynn Mack
- Diabetes, Endocrinology, & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vishal Kothari
- Department of Minimally Invasive Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura D Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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16
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Kim SJ, Cho YJ, Lee DW. Patients' first-year adherence to different anti-osteoporotic therapy after hip fractures. Injury 2021; 52:1506-1510. [PMID: 33223260 DOI: 10.1016/j.injury.2020.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoporosis medication treatment is recommended after geriatric fractures. However, the percentage of patients receiving anti-osteoporotic treatment after a hip fracture is extremely low. OBJECTIVES The aim of this study was to evaluate the adherence to different anti-osteoporotic medications in elderly patients following hip fracture. METHODS This retrospective study included 520 patients treated with osteoporotic hip fracture between March 2014 and June 2019. The patients were asked to choose the medication for osteoporosis treatment at discharge. Adherence was monitored by follow-up visits to the outpatient clinic at 1 year following surgery. RESULTS Of 520 patients with baseline data, osteoporosis medications were prescribed to 250 (48.1%) patients. Of these patients, 110 (44.0%) took subcutaneous denosumab, 69 (27.6%) took oral selective estrogen receptor modulator, 55 (21.0%) took intravenous bisphosphonate. At 12 months, we followed up 178 (71.2%) patients. Of those prescribed a bone protection medication, only 85 patients (34.0%) reported still taking their medication 1 year later. The rate of adherence to 6-month subcutaneous denosumab injection was significantly higher than that for quarterly intravenous bisphosphonates (p = 0.024) or daily oral tablets (p = 0.028). CONCLUSIONS This study revealed patients' adherence for osteoporosis treatments after hip fracture. 6-month subcutaneous denosumab injection was preferred over 3-month intravenous injection or daily oral tablets in this elderly population and exhibited significant lower discontinuation rates. However, because of the limited power of the study, further research is required to identify the reasons behind non-adherence and to improve adherence to anti-osteoporosis medications.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Korea.
| | - Yun Jae Cho
- Department of Orthopaedics, Hanil General Hospital 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Korea.
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Korea.
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17
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Poivret D, Goetz C, Zevering Y, Wilcke C, Noirez V. Effect of patient-led cooperative follow-up by general practitioners and community pharmacists on osteoporosis treatment persistence. Int J Rheum Dis 2021; 24:912-921. [PMID: 34058072 DOI: 10.1111/1756-185x.14146] [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: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
AIM Osteoporosis is a major risk factor for fractures. Poor persistence with osteoporosis medication hampers outcomes. This study assessed whether encouraging the formation of patient-led follow-up cooperatives between general practitioners (GPs) and community pharmacists improved medication persistence. METHODS All consecutive patients who attended an osteoporosis patient education program were invited to participate. They were given a logbook containing questionnaires they would bring to 6-monthly visits to their GP and pharmacist. The effect of this 3-year cooperative follow-up on persistence with medication and lifestyle changes was assessed. RESULTS In total, 121 patients (average age, 67 years; 93% female) participated. Poor cooperation between GPs and pharmacists was noted. Nevertheless, medication persistence ranged from 83% to 91% over the 6 visits. However, since patient drop-out rates were high and questionnaire return rates were low, a post-study medical chart review was performed. This confirmed that persistence was high (74%-83%) at 3 years post-enrollment, even for oral bisphosphonate-treated patients (73%-76%). However, adoption of anti-osteoporosis lifestyle changes was poor throughout the study: one- to two-thirds of the patients did not alter their diet, physical activity, or surroundings to prevent falls. CONCLUSION One study goal, namely, to encourage GPs and pharmacists to cooperate in patient follow-up, was not achieved. However, high medication persistence was observed. This may reflect the education program, patient empowerment, personalized attention from study personnel, and being in a study. Patient-centered approaches can thus significantly increase medication persistence in osteoporosis. Ongoing education may be needed to improve patient adoption of and persistence with lifestyle changes.
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Affiliation(s)
- Didier Poivret
- Department of Rheumatology, Mercy Hospital (CHR Metz-Thionville), Metz, France
| | - Christophe Goetz
- Clinical Research Support Unit, Mercy Hospital (CHR Metz-Thionville), Metz, France
| | - Yinka Zevering
- SciMeditor Medical Writing and Editing Services, Metz, France
| | - Christophe Wilcke
- Regional Union for Health Professionals-Pharmacists, Lorraine, Nancy, France
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18
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Canals-Ruiz L, Comellas M, Lizán L. Preferences, satisfaction and decision-making processes in osteoporosis treatment: a systematic review of the literature. J Comp Eff Res 2021; 10:629-645. [PMID: 33880940 DOI: 10.2217/cer-2020-0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.
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Affiliation(s)
| | | | - Luís Lizán
- Outcomes10, Castellon, Spain.,Department of Medicine, University Jaume I, Castellon, Spain
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19
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Terpos E, Zamagni E, Lentzsch S, Drake MT, García-Sanz R, Abildgaard N, Ntanasis-Stathopoulos I, Schjesvold F, de la Rubia J, Kyriakou C, Hillengass J, Zweegman S, Cavo M, Moreau P, San-Miguel J, Dimopoulos MA, Munshi N, Durie BGM, Raje N. Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol 2021; 22:e119-e130. [PMID: 33545067 DOI: 10.1016/s1470-2045(20)30559-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
In this Policy Review, the Bone Working Group of the International Myeloma Working Group updates its clinical practice recommendations for the management of multiple myeloma-related bone disease. After assessing the available literature and grading recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method, experts from the working group recommend zoledronic acid as the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, with or without multiple myeloma-related bone disease. Once patients achieve a very good partial response or better, after receiving monthly zoledronic acid for at least 12 months, the treating physician can consider decreasing the frequency of or discontinuing zoledronic acid treatment. Denosumab can also be considered for the treatment of multiple myeloma-related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem-cell transplantation. Denosumab discontinuation is challenging due to the rebound effect. The Bone Working Group of the International Myeloma Working Group also found cement augmentation to be effective for painful vertebral compression fractures. Radiotherapy is recommended for uncontrolled pain, impeding or symptomatic spinal cord compression, or pathological fractures. Surgery should be used for the prevention and restoration of long-bone pathological fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Suzanne Lentzsch
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Niels Abildgaard
- Hematology Research Unit, Department of Clinical Research, and Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Javier de la Rubia
- Department of Hematology, University Hospital Doctor Peset, School of Medicine and Dentistry, Catholic University of Valencia, Valencia, Spain
| | | | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Philippe Moreau
- Department of Hematology, University Hospital Hotel-Dieu, Nantes, France
| | - Jesus San-Miguel
- Center for Applied Medical Research, Clínica Universidad de Navarra, University of Navarra, and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikhil Munshi
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brian G M Durie
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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20
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Bhadada S, Pal R, Dhiman V. Prevention of vertebral fractures in primary osteoporosis with once-weekly teriparatide: A systematic review and meta-analysis of randomized controlled trials. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2021. [DOI: 10.4103/jncd.jncd_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Scarsi KK, Swindells S. The Promise of Improved Adherence With Long-Acting Antiretroviral Therapy: What Are the Data? J Int Assoc Provid AIDS Care 2021; 20:23259582211009011. [PMID: 33902356 PMCID: PMC8082990 DOI: 10.1177/23259582211009011] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
As with other chronic conditions, adherence to daily medications remains a challenge for many individuals living with HIV due to structural, behavioral, and social barriers. Unfortunately, high levels of adherence to antiretroviral therapy are required to maintain virologic suppression. Alternative approaches are being explored to decrease the burden of daily pill administration, including long-acting injectable, oral, and implantable products. Phase 3 data support the efficacy of nanoformulated injectable cabotegravir and rilpivirine for HIV treatment in patients with undetectable viremia, but we have yet to learn how this strategy may benefit those with medication adherence challenges. Despite this, the affected community and HIV providers are very interested in exploring the role of long-acting therapies to address some types of barriers to medication adherence. This review summarizes available information about the potential for long-acting therapy to improve adherence for some patients and outlines associated opportunities and challenges with the implementation of long-acting therapy for the treatment and prevention of HIV.
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Affiliation(s)
- Kimberly K. Scarsi
- Antiviral Pharmacology Laboratory, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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22
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Terpos E, Ntanasis-Stathopoulos I. Controversies in the use of new bone-modifying therapies in multiple myeloma. Br J Haematol 2020; 193:1034-1043. [PMID: 33249579 DOI: 10.1111/bjh.17256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
Bone-modifying therapies are essential in the treatment of patients with multiple myeloma. Zoledronic acid is preferred over other bisphosphonates due to its superiority in reducing the incidence of skeletal-related events and improving survival. The anti-receptor activator of nuclear factor-κΒ ligand (RANKL)-targeted agent denosumab has shown its non-inferiority compared to bisphosphonates in preventing skeletal-related events among newly diagnosed patients with myeloma bone disease. Denosumab may confer a survival benefit in patients eligible for autologous transplantation. Denosumab may present a safer profile for patients with renal impairment. Discontinuation of bone-directed therapies can be considered for patients with deep responses and after an adequate time period on treatment; however, a rebound effect may become evident especially in the case of denosumab. Three-monthly infusions of zoledronic acid or at-home denosumab administration should be considered during the coronavirus disease 2019 (COVID-19) pandemic. Measures to prevent hypocalcaemia, renal toxicity and osteonecrosis of the jaw are important for all bone-modifying agents.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kong L, Zuo K, Ma L. Clinical effect of Zoledronic Acid in the treatment of Senile Osteoporosis. Pak J Med Sci 2020; 36:1703-1707. [PMID: 33235601 PMCID: PMC7674899 DOI: 10.12669/pjms.36.7.1964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To investigate the clinical efficacy of zoledronic acid in the treatment of senile osteoporosis. Methods: One hundred and six cases of senile osteoporosis who visited to our hospital from August 2017 to December 2018 for treatment were selected and randomly divided into a control group and an observation group. The control group was treated with conventional therapy, while the observation group was treated with zoledronic acid in addition to the treatment of the control group. Bone mineral density, pain degree, therapeutic effect and adverse reactions of the two groups were compared. Results: The total effective rate of the observation group was 96.67%, higher than 80.00% of the control group (P<0.05); the bone mineral density of lumbar vertebrae, femoral neck and Ward’ area in the two groups increased after 6 months of treatment, and the bone mineral density of the observation group increased more than that of the control group (P<0.05); the pain degree of the observation group was lower than that of the control group after 6 months of treatment, and the difference was significant (P<0.05). There was no significant difference in the occurrence of adverse reactions between the two groups (P>0.05). Conclusion: Zoledronic acid is helpful to alleviate clinical symptoms, reduce the degree of bone pain, and promote the increase of bone mass, and has high safety in the treatment of senile osteoporosis, which is worth promotion.
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Affiliation(s)
- Li Kong
- Li Kong, Pharmacy Intravenous Admixture Services, Binzhou People's Hospital, Shandong 256610, P. R. China
| | - Kai Zuo
- Kai Zuo, Department of Infectious Diseases, Binzhou People's Hospital, Shandong 256610, P. R. China
| | - Long Ma
- Long Ma, Department of Emergency Station, Binzhou People's Hospital, Shandong 256610, P. R. China
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