Background/Purpose: Persistence with osteoporosis therapies is associated with clinical outcomes.  The goal of this study is to examine patient-reported persistence with zoledronic acid, a once-yearly bisphosphonate infusion, and to assess the factors associated with non-persistence with zoledronic acid therapy. 

Methods: A cross-sectional study of patients affiliated with a large US health plan was conducted via a mailed survey. The Optum Research Database was used to identify female patients receiving a zoledronic acid infusion (index date) 13-19 months prior to the November 2013 survey administration. Patients were required to be age 50 or older at index date with continuous enrollment in medical and pharmacy benefits and an osteoporosis diagnosis in the 6 months prior to the index date. Patients who received the index infusion in a long-term care institution or had a diagnosis of Paget’s disease or cancer during the 6-month pre-index period were excluded. Data collection included a pilot-tested patient survey to assess patient clinical and demographic characteristics, experiences associated with index zoledronic acid therapy (e.g., side effects and barriers to treatment), knowledge of osteoporosis and zoledronic acid therapy, attitudes toward medication, and availability of support for disease and therapy management. Mailed survey administration followed the Dillman tailored design method. Survey data were collected from November 2013 to January 2014. The chi-squared test was used to examine the differences in survey responses between patients who did and did not receive a follow-up infusion.

Results: Of the 391 surveys sent to patients identified for the survey, 111 returned the survey (response rate = 32.0%). The mean (SD) age of the respondents was 62.2 (7.4). Among the respondents, 55 (49.6%) reported having received their follow-up zoledronic acid infusion in the previous 6 months. The differences in demographic characteristics were not statistically significant between those who did and did not receive a follow-up infusion. Those who received a follow-up infusion were more likely to report having had a discussion with the physician regarding the need to return for additional infusions compared with those who did not return (98.2% vs. 83.9%; p=0.016). Patients who scheduled a follow-up appointment to receive another dose at the time of the initial infusion (n=27) were more likely to receive a follow-up infusion (74.1%) than those who did not schedule (43.6%) (p=0.006). Similarly, patients who reported having been contacted by the physician’s office about scheduling their next infusion (n=61) were more likely to receive a follow-up infusion (60.7%) than those who were not contacted (36.7%) (p=0.013). 

Conclusion: Results from the survey study show that half of the patients on zoledronic acid therapy for osteoporosis reported receiving a follow-up infusion 13 to 19 months after the index infusion.  Higher follow-up infusion rates were seen among patients who discussed the need to return for additional infusions with their physicians, scheduled a follow-up appointment for a follow-up infusion at the time of the index infusion, or received contact from the physician’s office about scheduling their next infusion.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-patient-survey-study-of-zoledronic-acid-utilization-and-factors-associated-with-persistence/