Real-world use of denosumab and bisphosphonates in patients with solid tumours and bone metastases in Germany
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ORIGINAL ARTICLE
Real-world use of denosumab and bisphosphonates in patients with solid tumours and bone metastases in Germany Ingo Diel 1
&
Sonja Ansorge 2 & David Hohmann 3 & Christina Giannopoulou 4 & Daniela Niepel 5 & Michele Intorcia 4
Received: 18 June 2019 / Accepted: 11 February 2020 # The Author(s) 2020
Abstract Purpose Bisphosphonates 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. Methods Adults 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. Results This 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%). Conclusions Patients 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. Keywords Bisphosphonates . Bone metastases . Compliance . Denosumab . Discontinuation . Persistence
Introduction Bone metastases are common in patients with advanced solid tumours [1–3]; they affect 68% of patients with prostate
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05357-5) contains supplementary material, which is available to authorized users. * Ingo Diel [email protected] 1
Centre for Gynecological Oncology, Praxisklinik am Rosengarten, Augustaanlage 7-11, 68165 Mannheim, Germany
2
Vilua Healthcare GmbH, Munich, Germany
3
Amgen GmbH, Munich, Germany
4
Amgen Europe GmbH, Rotkreuz, Switzerland
5
Amgen (Global), Rotkreuz, Switzerland
cancer (> 90% of patients with metastatic castration-resistant disease), 73% with breast cancer and 36% with lung cancer [2, 3]. Bone metastases can lead to debilitating bone complications, known as skeletal-related events (SREs), which include pathologic fractures, spinal cord compression and the need for radiation or surgery to the bone [4]. Bone complications can cause pain, reduce patient qual
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