Abstract
PurposeBisphosphonates and denosumab prevent bone complications in patients with bone metastases from solid tumours. This retrospective, longitudinal, cohort study provides data on their real-world use in this setting in Germany.MethodsAdults with bone metastases from breast, prostate or lung cancer who were newly initiated on a bisphosphonate or denosumab between 1 July 2011 and 31 December 2015 were identified from a German healthcare insurance claims database. Primary outcomes included persistence, compliance, discontinuation and switch rates at 12 months.ResultsThis study included 1130 patients with bone metastases: 555 (49%) had breast cancer, 361 (32%) prostate cancer and 242 (21%) lung cancer. Mean age was 65 years for patients with breast or lung cancer and 74 years for those with prostate cancer. Across all tumour types, compared with any bisphosphonate, 12-month persistence was higher with denosumab (breast cancer 78% vs 54–58%, prostate cancer 58% vs 50%, lung cancer 68% vs 34–60%), median time to discontinuation was longer with denosumab and switch rates were lower for denosumab (breast cancer 5% vs 14–19%, prostate cancer 2% vs 11%, lung cancer 3% vs 7–12%). Compliance at 12 months was longer for denosumab than for any bisphosphonate in breast cancer (75% vs 42–48%) and in prostate cancer (47% vs 36%).ConclusionsPatients initiated on denosumab following a diagnosis of bone metastases from breast, prostate or lung cancer had greater medication persistence, longer time to discontinuation, improved compliance and lower switch rates than those initiated on a bisphosphonate.
Highlights
Bone metastases are common in patients with advanced solid tumours [1,2,3]; they affect 68% of patients with prostateElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.As the cancer treatment landscape evolves and survival outcomes improve, the long-term implications of supportive care become increasingly relevant to clinical decisionmakers
Bisphosphonates and denosumab are approved for prevention of bone complications in patients with advanced malignancies involving bone [14,15,16,17,18]
Bisphosphonates and denosumab have different pharmacokinetic profiles owing to their differing mechanisms of action; zoledronic acid has a half-life of 2–189 days and may remain in bone for up to 10 years, whereas denosumab is not incorporated into the bone and has a mean half-life of 14–55 days [14, 15, 22]
Summary
Bisphosphonates are synthetic analogues of pyrophosphonate (a natural regulator of bone metabolism) that are incorporated into the bone, and reduce bone resorption by inhibiting the differentiation and activation of osteoclasts [14, 16,17,18,19,20] They are administered as an intravenous (IV) infusion every 3–4 weeks (zoledronic acid, pamidronate disodium, ibandronate) or orally every day (ibandronate and clodronate) [14, 16,17,18,19]. Bisphosphonates and denosumab reduce the incidence of bone complications in patients with bone metastases from solid tumours [23,24,25], with denosumab showing superiority compared with zoledronic acid in patients with breast [26] and prostate cancer [27] and non-inferiority in patients with multiple myeloma and other solid tumours [28]. These agents have been shown to prevent pain progression and the worsening of patient QoL [5], with denosumab shown to be more effective than zoledronic acid in these dimensions [29]
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