Adherence with oral bisphosphonates in patients with rheumatoid arthritis

This study examined adherence with oral bisphosphonates (BPs) in people with rheumatoid arthritis (RA). It was determined that adherence was low in these patients.

RA is a disease in which the body’s immune system attacks the joints (connections between bones). There are two types of RA; seropositive and seronegative. People with seropositive RA have special antibodies (proteins found in blood). Those with seronegative RA do not.

Osteoporosis is one of the major complications of RA. Osteoporosis is a condition that weakens the bones and makes them more prone to fracture.

BPs are a type of drug that prevent the breakdown of bone. They are effective in treating osteoporosis. Poor adherence with BP treatment increases the risk of fracture. Adherence has two components; compliance and persistence. Compliance is how well the patient follows the prescribed dose and interval of treatment. Persistence is the total time that the patient spends being treated.

Previous studies have found that adherence with BP treatment is low. However, most of these focus on post-menopausal osteoporosis. Little attention has been given to patients with RA.

This study examined 396 women with RA. These women had just begun treatment with oral BPs. Their compliance was examined after 1 year by investigating how often they filled their prescriptions. If they filled their prescriptions more than 80% of the time, they were said to be compliant. Any participant who was still taking BPs, without stopping for more than 56 days, was said to be persistent.

After 1 year 60.1% of participants were compliant. Those who received BPs every month were more compliant than those who received BPs every week. Those with seropositive RA and those who had had RA for more than 2 years were more compliant. Those who took vitamin D and/or calcium supplements were less compliant than those who did not.

63.3% of patients were persistent after 1 year. This fell to 50.7% after 2 years, and 33.3% after 3 years. In total, 274 patients (69.2%) stopped taking BPs during the study. 47.5% stopped due to side effects. The most common reported side effect were gastrointestinal issues. 40.5% stopped due to a lack of understanding of the importance of osteoporosis treatment. 12% stopped due to cost. Persistence was better in those who took monthly BPs than in those who took weekly BPs. Persistence was also higher in participants with seropositive RA than in those with seronegative RA. 

The study concluded that adherence with oral BPs in patients with RA was generally low. They noted that adherence was better in those who took monthly BPs and in those with seropositive RA. 

This study only examined female patients, with an average age of 66 years. Thus the results may not apply equally to all people with RA. 

Discuss the use of BPs with your physician.