Boniva vs. Fosamax vs. Actonel

Discussion in 'Osteoporosis' started by Anonymous, Jul 18, 2007 at 11:33 AM.

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  1. Anonymous

    Anonymous Guest

    So honestly. Which one sells better? I have to decide on a job selling Boniva.
     

  2. Anonymous

    Anonymous Guest

    Most of my docs prescribe Fosamax because of long term data. Some are rx'ing Boniva, but once a week or once a month isn't a biggy vs. long term use. Also, Fosamax is the most requested by patients.
     
  3. Anonymous

    Anonymous Guest

    Hey, I'm a patient (yes, an old one) i had a choice and went with Fasomax D rather then Boniva. You're so right, long term data and the once a week rather than once a month was no big deal=the long term data. Discussed it with my OBGYN, family dr and even my dentist.
     
  4. Anonymous

    Anonymous Guest

    How about Evista?
     
  5. Anonymous

    Anonymous Guest

    Fosamax has the largest market share and long term data, but is fast becoming an antiquated therapy. Boniva's clinical trial data has only proven fracture benefit at the spine (nothing at the hip or anywhere beyond the spine...unless they slice and dice the data, and pull out a very sick patient population with t-scores <= -3.0). Actonel is the therapy chosen by most specialists in the field, primarily because of the strong prospective antifracture data the drug has consistently across the body...including the all important wrist and hip fractures. THIS IS SOMETHING THAT FOSAMAX and CERTAINLY NOT BONIVA can state...

    Bottom line: Fosamax is written by slow to change and habit-driven dinosaurs...Boniva is written by docs who believe that direct-to-consumer adtertising is more important than clinical efficacy...

    Actonel is certainly the best when it comes to protecting patients from fractures...hands down...
     
  6. Anonymous

    Anonymous Guest

    And now the new guy Reclast comes on the market and will blow the data on all the others out of the water. Has great fracture vertebral and non vertebral plus hip plus BMD increases all better than the others. Understandably patients are getting all of the drug no doubt where with the orals there is a big non compliance.
     
  7. Anonymous

    Anonymous Guest

    Two words, Reclast poster: "atrial fibrillation"...Novartis will assume Merck's place on the lawsuit chopping block once patients start dropping like flies. Reclast provides modest efficacy, places too much emphasis on BMD (if you knew anything about bone you might know about the huge BMD changes of fluoride that yielded no fracture benefit), costs way too much money, and will NEVER hit the mainstream.

    Once 150 mg Actonel launches, then all bets are off...docs and pts in the mainstream market will love it.

    Oh, and as far as Boniva goes, I heard that Sally Field broke her wrist on the set of "daughters".
     
  8. Anonymous

    Anonymous Guest

    I'm a -3 w/Osteop. Tried Boniva last year. had bad reaction, put my whol body in a charlie horse state condition for 3 days. MRI's Xrays couldn't find anything. Screw Sally Fields.
     
  9. Anonymous

    Anonymous Guest

    Have your Vitamin D levels checked, get them up to par and them go back on Boniva!
     
  10. Anonymous

    Anonymous Guest

    Forteo has the best data by FAR...we are all lucky it costs so much.
     
  11. Anonymous

    Anonymous Guest

    I'm a 74 year-old woman with serious osteoporosis. I have refused oral bisphosphonates because of their association with esophageal bleeding and ulceration (I can see why Fosamax compliance is something like 50%). But I am at huge risk of fracture. When I heard about Reclast I requested it and was referred to an osteoporosis specialist who required many, many lab tests and also dental OK before she cleared me. I am now scheduled for the first infusion next week. I understand the risks. I don't feel that I have much choice. My reasoning is the following: a heart arrhythmia is easier to manage than a broken back. Worst case scenario would be medication, pacemaker, defibrillator. This isn't entirely fanciful; my husband has lived with all of the above for nearly twenty years so it's something I'm more or less OK with. With all of that, I could still maintain independent functioning. With a busted behind, I couldn't even go to the grocery store. Just going downstairs to get the mail would be problematic. When you are young you expect to avoid all bad stuff. As you get older you begin to think in terms of comparative manageability. As I anticipate starting Reclast I feel as if I am voluntarily walking into the ocean, but am gambling that any side effects will be the lesser of many evils. This doesn't feel trivial. Actually I was thinking that while I am getting the infusion it would be suitable to have the Mormon Tabernacle Choir there singing a Te Deum. Wish me luck with this. And thanks to all of you young experts who make these drugs accessible.
     
  12. Anonymous

    Anonymous Guest

    SO-O-O, how did it go for you? Were you sick the first 3 days? How did you handle it? I'm scheduled for infusion on the 7th of April, and would like all the personal info available. THANX!
     
  13. Anonymous

    Anonymous Guest

    OK, let me straighten everyone out...

    Oral bisphosphonates (boniva, fosamax, actonel) are all extremely similar. Their ONLY function is to inhibit bone loss. This allows the body to then have a better balance on bone remodeling, which means it can naturally build bone, therefore improving bone health. Good bone health is what reduces fractures, & is dependent on much more than the drugs. You must have good levels of calcium & vitamin D as well, otherwise, the drugs will be of little benefit.

    Which is the best? The one each patient is most compliant with! We do know, however, that bisphosphonates are literally toxic to the esphogeal lining. This is why less exposure (less dosing) is safer, so my vote is clealy with once-monthly boniva. They all have similar numbers of pivotal trials. "Long term data" means nothing more than the length of time the drugs have been on the market. All have been on long enough to prove they are safe & effective. (Fosamax may be the most prescribed, but that's only because it has been on the market the longest, their company gives the highest rebates to the managed care companies, and because most doctors form habits & don't have osteoporosis high enough on their radar screen to care enough about changing their habits. Sad, I know).

    From a pure numbers perspective, fosamax & boniva are the best. Fosmax conducted a head-to-head trial with actonel & was proved statistically superior over actonel. Then, boniva conducted a head-to-head with fosamax & proved statistically equivalent to fosamax. Actonel is a good bisphosphonate, it's just that the mg strength is too low. Sorry actonel, the truth hurts.

    Regarding nonvertebral fracture reduction...it's all VERY inconsistent & NOT required by the FDA for approval. Osteoporosis shows up first in the spine, therefore, the FDA requires drugs to prove efficacy in the spine ONLY. Fosamax was the only one to prove hip fracture reduction, but only by 1 fracture in 1 trial. In their other pivotal trial, they could not prove statistical significance. Actonel showed nonvertebral reductions in 1 trial, though not statistically significant hip data, and could not show nonvert in their 2nd trial. Boniva could not prove nonvert, but had a healthy patient population - they were not osteoporotic at the hip, so how do you show fracture protection when you're not at risk for fracture?) Even Forteo, strongly considered to be the best agent for osteoporosis therapy, could NOT show statistically significant hip fracture reduction!!!!

    Besides, all of the "fracture data" lies within the trials from the "daily doses" which are no longer used. The FDA allowed "bridging" studies based on bone mineral density ONLY, to prove "non-inferiority" to the new extended dose versions. So, fracture reduction cannot be claimed on the extended dose oral bisphosphonates, only implied fracture protection through improved bone health.

    Regarding IV bisphosphonates, reclast has best in class data, but also has significant safety issues. Boniva has an IV injection, which also has good bisphosphonate data, but with much fewer safety concerns, most importantly, NO cardiovascular side effects. So, to the 74 yo willing to accept possible arrhythmias...you don't have to worry about this with boniva injection. Did you have cardio issues before starting reclast? If you're "specialist" didn't give you boniva injection as an option, I would suggest getting a new specialist & then contacting a good lawyer if you develop cardio issues!

    Hope this clears things up out there! Dr Anonymous
     
  14. Anonymous

    Anonymous Guest

    Oh, so sad! Boniva rep...it's obvious you have responded making the Boniva, Fosamax, Actonel comparison. You should get your facts straight and stop misleading the public!
     
  15. Don't do it dude. Actonel OAM and Reclast will double dog you big time. You won't get paid.

    Plus generic fosamax will come in and bang you in the pie hole even harder because it will push you to Tier 3 or not covered.

    You'd better bet would be to sell crack than to sell Boniva right now. They're pretty much fucked.
     
  16. Anonymous

    Anonymous Guest

    Anonymous Posts: n/a

    Re: Boniva vs. Fosamax vs. Actonel

    --------------------------------------------------------------------------------

    OK, let me straighten everyone out...

    Oral bisphosphonates (boniva, fosamax, actonel) are all extremely similar. Their ONLY function is to inhibit bone loss. This allows the body to then have a better balance on bone remodeling, which means it can naturally build bone, therefore improving bone health. Good bone health is what reduces fractures, & is dependent on much more than the drugs. You must have good levels of calcium & vitamin D as well, otherwise, the drugs will be of little benefit.

    Which is the best? The one each patient is most compliant with! We do know, however, that bisphosphonates are literally toxic to the esphogeal lining. This is why less exposure (less dosing) is safer, so my vote is clealy with once-monthly boniva. They all have similar numbers of pivotal trials. "Long term data" means nothing more than the length of time the drugs have been on the market. All have been on long enough to prove they are safe & effective. (Fosamax may be the most prescribed, but that's only because it has been on the market the longest, their company gives the highest rebates to the managed care companies, and because most doctors form habits & don't have osteoporosis high enough on their radar screen to care enough about changing their habits. Sad, I know).

    From a pure numbers perspective, fosamax & boniva are the best. Fosmax conducted a head-to-head trial with actonel & was proved statistically superior over actonel. Then, boniva conducted a head-to-head with fosamax & proved statistically equivalent to fosamax. Actonel is a good bisphosphonate, it's just that the mg strength is too low. Sorry actonel, the truth hurts.

    Regarding nonvertebral fracture reduction...it's all VERY inconsistent & NOT required by the FDA for approval. Osteoporosis shows up first in the spine, therefore, the FDA requires drugs to prove efficacy in the spine ONLY. Fosamax was the only one to prove hip fracture reduction, but only by 1 fracture in 1 trial. In their other pivotal trial, they could not prove statistical significance. Actonel showed nonvertebral reductions in 1 trial, though not statistically significant hip data, and could not show nonvert in their 2nd trial. Boniva could not prove nonvert, but had a healthy patient population - they were not osteoporotic at the hip, so how do you show fracture protection when you're not at risk for fracture?) Even Forteo, strongly considered to be the best agent for osteoporosis therapy, could NOT show statistically significant hip fracture reduction!!!!

    Besides, all of the "fracture data" lies within the trials from the "daily doses" which are no longer used. The FDA allowed "bridging" studies based on bone mineral density ONLY, to prove "non-inferiority" to the new extended dose versions. So, fracture reduction cannot be claimed on the extended dose oral bisphosphonates, only implied fracture protection through improved bone health.

    Regarding IV bisphosphonates, reclast has best in class data, but also has significant safety issues. Boniva has an IV injection, which also has good bisphosphonate data, but with much fewer safety concerns, most importantly, NO cardiovascular side effects. So, to the 74 yo willing to accept possible arrhythmias...you don't have to worry about this with boniva injection. Did you have cardio issues before starting reclast? If you're "specialist" didn't give you boniva injection as an option, I would suggest getting a new specialist & then contacting a good lawyer if you develop cardio issues!

    Hope this clears things up out there! Dr Anonymous

    _______________________________________________________________

    Check your data again. To say that the data backing Fosamax or Boniva is better than Actonel's data shows just how misguided you are about the facts.
    The first head-to-head trial, the so-called "FACT" trial was nothing more than a BMD study w/fractures measured only as a side affect. Guess what; there were more fractures in the alendronate group than the risedronate group. The second "FACT" trial was also a BMD study, only this time they set it up so that the side affect fracture total was fairly equal.

    Drugs that are supposed to prevent patients from fracturing should have FRACTURE PREVENTION as their primary endpoint, not some surrogate marker. Fosamax origionally had a wrist fracture indication but had it pulled because of lack of efficacy proved in FRACTURE PREVENTION.

    Then it gets even better. There have been studies showing that there are indeed differences among the bisphosphonates w/regard to the amount of time that the various drugs "stick to the bone". Some come off the bone quicker than others and spread to different sites compared to others. Their are also difference among the drugs concerning their affinity for certain receptors in the osteoclast and their ability to cause apoptosis.

    Check the headlines for current articles on long bone fractures w/Fosamax.
    Word is that Paul Miller, MD is close to publishing an article connecting long term (over five year) usage of alendronate(Fosamax) and non-traumatic radial fractures in the femurs of osteoporosis patients. Literature also has one case so far of this happening already in a Reclast patient.

    Who would take Boniva when it has much less data on protecting against non-vertebral fractures (including HIP), patients have to wait an extra half hour before eating breakfast, it generally has a higher co-pay and the pill itself is twice as big as the 150mg OAM Actonel?

    Their are differences.

    Really clearing things up.
     
  17. Anonymous

    Anonymous Guest

    You are all so sick in your mind, this is unbelievable: Now all of you selling boniva I want you to go on this site:
    http://www.askapatient.com/viewrating.asp?drug=21455&name=BONIVA
    you are selling fosamax? Here we go:
    http://www.askapatient.com/viewrating.asp?drug=20560&name=FOSAMAX
    actonel is dito!

    Now speaking of efficacy:
    Read this!
    http://www.reuters.com/article/pressRelease/idUS185384+14-Dec-2007+PRN20071214

    Speaking of safety! There is only one that is safe and this is miacalcin or fortical which is the generic.

    calcitonin helps by the way also with pain and increased the quality of life!
    http://sciencelinks.jp/j-east/article/200514/000020051405A0457975.php
    http://www.springerlink.com/content/w6451654w00164h4/

    The future will be in the calcitonin, believe it or not ..
    http://www.ncbi.nlm.nih.gov/pubmed/18481897?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
     
  18. Anonymous

    Anonymous Guest

    All this information about Boniva vs. Fosamax vs. Actonel would be much more convincing if those who are offering it (supposedly doctors?) could spell!
     
  19. Anonymous

    Anonymous Guest

    My feelings exactly!
     
  20. Anonymous

    Anonymous Guest

    What about just good ol' Calcium with D?