Socioeconomic vulnerability and osteoporosis treatment disparities during COVID-19 lockdown among U.S. medicare enrollees who initiated romosozumab.

UNLABELLED: Higher area socioeconomic level was associated with a decreased risk of romosozumab discontinuation during COVID-19 lockdown among U.S. Medicare beneficiaries. Patients in these areas were more likely to restart osteoporosis treatment post-discontinuation. Timely support for vulnerable patients is crucial for improving adherence during public health crises.

PURPOSE: To evaluate the association between area socioeconomic (SES) vulnerability and the discontinuation of romosozumab and the impact of the COVID lockdown on osteoporosis treatment among women enrolled in the U.S. Medicare who initiated romosozumab.

METHODS

Female Medicare beneficiaries aged 65 and older who initiated romosozumab between April 2019 and September 2020 were included. Discontinuation was defined as a > 60-day gap between doses. SES vulnerability was assessed using the county-level Social Vulnerability Index SES theme. A Discontinuation Risk Score (DcRS) was calculated to control for individual characteristics. A Cox proportional hazards model evaluated the association between county SES and discontinuation. Secondary analyses examined treatment restart within six months post-discontinuation.

RESULTS

The study included 6,777 new romosozumab users. Higher area SES level (lower vulnerability) was associated with a reduced risk of discontinuation during the COVID-19 lockdown (adjusted HR = 0.79 [0.68, 0.92] for the highest vs. lowest SES). Of 2,937 patients who discontinued, 1,816 restarted osteoporosis treatments within 6 months, including 661 switching to other medications. Patients in the highest SES group were more likely to restart osteoporosis treatment during lockdown (adjusted HR = 1.14 [1.01-1.30]) comparing with the lowest SES group, which is primarily driven by treatment switch (adjusted HR = 1.30 [1.06-1.60]).

CONCLUSION

Medicare beneficiaries in counties with higher SES level (lower vulnerability) were less likely to discontinue romosozumab during the COVID-19 lockdown and more likely to switch treatments if discontinued, resulting in shorter treatment gaps. Providing timely support to vulnerable patients is vital for maintaining treatment adherence during future public health emergencies.