Osteo Update

The National Osteoporosis Society Conference held in June 2009 featured a sponsored symposium launching Servier's Protelos (strontium ranelate) patient support programme Embrace.

Professor John Weiman, Professor of Psychology as applied to Medicine at the Institute Psychiatry at Kings College, London, presented evidence for supporting people with chronic diseases, including osteoporosis, which set the scene for why the Embrace programme is needed.

Embrace will provide healthcare professionals with feedback on patient disease management beliefs and materials to educate and support their patients. All patients prescribed Protelos can join the Embrace patient support programme. Protelos is an osteoporosis treatment which helps to increase bone formation and decrease bone resorption, thereby reducing the risk of fracture.¹

The Embrace programme aims to provide:

• Timely communications to assist long-term adherence
• Empathy, encouragement and motivation
• Appropriate information and support
• Drug administration advice

The structure of the support that Embrace will provide patients on Protelos therapy is as follows:

Embrace Healthcare Professional Guide and Patient enrolment form

Non-adherence

Professor Weiman started his talk by exploring why patients do not follow their prescribed treatment regimens. He highlighted that a large body of research on this exists, which explores the patterns and factors relating to non-adherence, and the size of the problem. According to the World Health Organization's 2003 adherence report² around 50% of the treatments prescribed in developed countries to patients with long-term conditions are not taken.

Professor Weiman then set about dispelling some of the common myths about adherence.

• Different disease areas have different levels of treatment adherence - not true. The non-adherence rates for most long-term conditions are between 30-50%.²
• There are certain types of patients who will be non-adherent - not true. Most patients will be non-adherent some of the time. In other words, a patient's adherence varies over time.
• Non adherence is easily fixed - not true. For long-term treatment, most simple interventions don't work that well.³

He went on to explain that non-adherence can be considered to be of two types:

Unintentional non-adherence - in which patients either lack the skills or the knowledge to comply with their therapy. The reasons for unintentional non-adherence include poor healthcare professional to patient communication, poor forward planning ability, and lack or money. Unintentional non-adherence is often what interventions are aimed at addressing.

Intentional non-adherence - in which patients make a conscious decision not to follow their treatment regimen. This has much more to do with patients' motivation and the beliefs that they have. Intentional non-adherence represents the bulk of the problem, and is difficult to address.

Patients' beliefs

Most patients who initiate a medication for osteoporosis do not continue to take it as prescribed.⁴ They will resist taking a medication if the treatment does not make sense to them or if they don't believe it will work. Patients exhibit two categories of belief - beliefs about their illness and beliefs about their treatment.

A patient has his or her own views about their illness, which can differ widely from fact. Core beliefs include:

• What the condition is and its symptoms
• The causes
• The time course of the condition
• How the illness will affect them
• Curability/control

Regarding treatment, patients have two broad beliefs

• About the treatments they are currently on; and
• About treatments in general

Those patients who exhibit intentional non-adherence are usually found to have doubts about the effectiveness of the treatment for them and concerns about its adverse effects. For each patient, healthcare professionals need to find out about their individual motivation (perceptions) and ability (practicalities).

Support and follow up of the patient is very important if non-adherence is to be tackled, and it is in the early period of treatment when a patient needs this support the most. A better understanding of a patient's perspectives of their illness and treatment is key to understanding why patients don't adhere.

Servier's Embrace patient programme will offer a personalised method of identifying and addressing key barriers to adherence, and provide support for that very important early period.

Protelos - moving forward

Also during the Servier sponsored symposium at the NOS meeting, Professor Tim Spector of the Twin Research and Genetic Epidemiology Unit at St Thomas' Hospital London, emphasised that Protelos should no longer be considered a 'new' treatment, having been launched in 2004, but that its mode of action remains novel. Although much is now known about Protelos, how best to use this drug still needs to be established.

Professor Serge Ferrari, Associate Professor of Medicine and Osteoporosis Genetics, Geneva University Hospital, Switzerland, discussed the determinants of bone strength, focusing the fact that Protelos offers a different mechanism of action compared with other osteoporosis therapies, affecting bone density and material properties of bone tissues.

Dr Mike Stone, Consultant Physician at Llandough Hospital, South Glamorgan, presented data and case studies that suggest advantages of using strontium ranelate in the elderly. As bone ages its quality decreases. Bisphosphonates may not always be the most appropriate treatment, and perhaps strontium ranelate should be the treatment of choice in the elderly.

References

^1. Reginster JY et al. Effects of long-term strontium ranelate treatment on the risk of non-vertebral and vertebral fractures in postmenopausal osteoporosis: results of a 5-year randomised placebo-controlled trial. Arthritis & Rheum 2008;58(6):1687-95
^2. World Health Organization. Adherence to long-term therapies. 2003
^3. Haynes R et al. Interventions for enhancing medication adherence. Cochrane database 2008
^4. Solomon D et al. Compliance with osteoporosis medications. Arch Intern Med 2005; 165(24):2414-19

Date of Preparation: July 2009: 09PRT115