Treatment dynamics of bone-targeting agents among men with bone metastases from prostate cancer in the United States

Anne M. Butler, Karynsa Cetin, Rohini K. Hernandez, B. Diane Reams, Robert A. Overman, Jung I. Kim, Bradford R. Hirsch, Amy P. Abernethy, Alexander Liede, M. Alan Brookhart

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish
Pages (from-to)229-238
Number of pages10
JournalPharmacoepidemiology and drug safety
Issue number2
StatePublished - Feb 2018


  • bone-targeting agents
  • competing risks
  • electronic health record data
  • patterns of use
  • pharmacoepidemiology
  • prostate cancer


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