TY - JOUR
T1 - Treatment dynamics of bone-targeting agents among men with bone metastases from prostate cancer in the United States
AU - Butler, Anne M.
AU - Cetin, Karynsa
AU - Hernandez, Rohini K.
AU - Diane Reams, B.
AU - Overman, Robert A.
AU - I. Kim, Jung
AU - Hirsch, Bradford R.
AU - Abernethy, Amy P.
AU - Liede, Alexander
AU - Alan Brookhart, M.
N1 - Funding Information:
The authors thank Flatiron for providing data for this study and thank Charlotte Rocker, Rachael Sorg, and Sandy Griffith for guidance about the data. Results presented at the 2016 International Conference on Pharmacoepidemiology and Therapeutic Risk Management (abstract #971) and the 2016 American Society of Clinical Oncology Annual Meeting (abstract #168243 for publication only) with abstracts entitled “Initiation and adherence with bone-targeting agents in US men with bone metastases from prostate cancer.” This study was supported by a research contract with Amgen, Inc., Thousand Oaks, CA.
Publisher Copyright:
Copyright © 2018 John Wiley & Sons, Ltd.
PY - 2018/2
Y1 - 2018/2
N2 - Purpose: To examine the dynamics of treatment with 2 bone-targeting agents (BTAs)—denosumab and zoledronic acid—among men with bone metastases from prostate cancer. Methods: Using electronic health record data from oncology practices across the US, we identified prostate cancer patients diagnosed with bone metastasis in 2012/2013 without evidence of BTA use within 6 months prior to diagnosis. We examined the risk and predictors of BTA initiation, interruption, and re-initiation. Results: Among 897 men diagnosed with prostate cancer, the cumulative incidence of BTA initiation after bone metastasis diagnosis was 34% (95% confidence interval [CI], 31–37%) at 30 days, 64% (95% CI, 61–68%) at 180 days, and 88% (95% CI, 85–91%) at 2 years. Denosumab was initiated more frequently than zoledronic acid. Men with diabetes, more bone lesions, history of androgen deprivation therapy, or no hospice enrollment were more likely to initiate treatment. Following initiation, the cumulative incidence of treatment interruption was 17% (95% CI, 14–19%) at 60 days and 70% (95% CI, 66–74%) at 2 years, with interruption more likely among patients receiving emerging therapies for prostate cancer or enrolling in hospice. The cumulative incidence of re-initiation following interruption was 36.3% (95% CI, 32.7–40.2%) at 15 days, 49.8% (95% CI, 45.9–54.1%) at 30 days, and 81.0% (95% CI, 77.5–84.7%) at 1 year. Conclusions: Bone-targeting agent therapy is initiated by the majority of men living with bone metastases following a prostate cancer diagnosis; however, the timing of initiation is highly variable. Once on treatment, gaps or interruptions in therapy are common.
AB - Purpose: To examine the dynamics of treatment with 2 bone-targeting agents (BTAs)—denosumab and zoledronic acid—among men with bone metastases from prostate cancer. Methods: Using electronic health record data from oncology practices across the US, we identified prostate cancer patients diagnosed with bone metastasis in 2012/2013 without evidence of BTA use within 6 months prior to diagnosis. We examined the risk and predictors of BTA initiation, interruption, and re-initiation. Results: Among 897 men diagnosed with prostate cancer, the cumulative incidence of BTA initiation after bone metastasis diagnosis was 34% (95% confidence interval [CI], 31–37%) at 30 days, 64% (95% CI, 61–68%) at 180 days, and 88% (95% CI, 85–91%) at 2 years. Denosumab was initiated more frequently than zoledronic acid. Men with diabetes, more bone lesions, history of androgen deprivation therapy, or no hospice enrollment were more likely to initiate treatment. Following initiation, the cumulative incidence of treatment interruption was 17% (95% CI, 14–19%) at 60 days and 70% (95% CI, 66–74%) at 2 years, with interruption more likely among patients receiving emerging therapies for prostate cancer or enrolling in hospice. The cumulative incidence of re-initiation following interruption was 36.3% (95% CI, 32.7–40.2%) at 15 days, 49.8% (95% CI, 45.9–54.1%) at 30 days, and 81.0% (95% CI, 77.5–84.7%) at 1 year. Conclusions: Bone-targeting agent therapy is initiated by the majority of men living with bone metastases following a prostate cancer diagnosis; however, the timing of initiation is highly variable. Once on treatment, gaps or interruptions in therapy are common.
KW - bone-targeting agents
KW - competing risks
KW - electronic health record data
KW - patterns of use
KW - pharmacoepidemiology
KW - prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85041324848&partnerID=8YFLogxK
U2 - 10.1002/pds.4360
DO - 10.1002/pds.4360
M3 - Article
C2 - 29316026
AN - SCOPUS:85041324848
SN - 1053-8569
VL - 27
SP - 229
EP - 238
JO - Pharmacoepidemiology and drug safety
JF - Pharmacoepidemiology and drug safety
IS - 2
ER -