Impact of clinical pharmacist-led interventions on denosumab adherence

Pharmacist-led interventions significantly improved denosumab adherence in patients with osteoporosis at an academic medical center, reducing non-adherence from 20.8 to 4.9%. This quality improvement initiative included pharmacist-led medication counseling and laboratory monitoring, highlighting the effectiveness of pharmacist-physician collaboration in preventing rebound-associated vertebral fractures and enhancing patient outcomes.

Interrupting or delaying denosumab beyond 7 months (210 days) from the last injection leads to transient increase in bone turnover known as rebound phenomenon, resulting in rapid loss of bone density and increased risk of vertebral fracture(s), now known as rebound-associated vertebral fractures (RAVF). Numerous studies suggest that clinical pharmacist participation in chronic disease state management leads to an increase in medication adherence and positive clinical outcomes. We evaluated the impact of a clinical pharmacist intervention on adherence to optimal denosumab timing for patients with osteoporosis.

The model for improvement was used to design and evaluate this quality improvement project. This study analyzed 143 patients receiving denosumab therapy in an osteoporosis clinic every 6 months for the indication of osteoporosis. At baseline, 21% of patients receiving denosumab did not receive the medication at optimal time intervals for clinical effectiveness. An administration was considered correct or on time if denosumab was given within 210 days of the last injection received. If the injection was given outside this window, it was considered incorrect administration. The incidence of correct and incorrect administrations was gathered to calculate the non-adherence rate. Clinical pharmacist interventions included patient counseling and electronic dosing reminders and phone calls. The aim of this study was to reduce the nonadherence rate from 20.8% to less than 5.0% by July 31, 2023.

With these interventions, the number of correct administrations between incorrect administrations improved from an average of 3.3 to 13.1. These effects became visible about 10 weeks after the second intervention and correspond to a reduction in nonadherence rate from 20.8 to 4.9% by July 31, 2023.

Pharmacist-physician collaboration can reduce the nonadherence rate for drugs such as denosumab, interruption of which can result in serious consequences.