Adherence and persistence in patients with type 2 diabetes mellitus newly initiating canagliflozin, dapagliflozin, dpp-4s, or glp-1s in the United States. (3rd July 2017)

• Record Type: Journal Article
• Authors: Cai, Jennifer; Divino, Victoria; Burudpakdee, Chakkarin
• Is Part Of: Current medical research and opinion. Volume 33:Number 7(2017)
• Page Start: 1317
• Page End: 1328
• Publication Date: 2017-07-03
• Subjects: Diabetes mellitus -- type 2 -- medication adherence -- persistence -- retrospective studies -- sodium-glucose transporter 2 inhibitors -- canagliflozin -- dapagliflozin; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2017.1320277
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objective: Sodium-glucose co-transporter 2 inhibitors were first approved in the US in 2013; therefore, real-world (RW) studies describing outcomes are limited. This retrospective study evaluated adherence and persistence among patients initiating canagliflozin (CANA), dapagliflozin (DAPA), GLP-1 agonists (GLP-1s), and DPP-4 inhibitors (DPP-4s) over a 12-month follow-up from a US managed care perspective. Methods: Patients newly initiating CANA, DAPA, GLP-1s, or DPP-4s from February 1, 2014–June 30, 2014 were identified from the QuintilesIMS PharMetrics Plus Database. The first fill defined the index date/drug. Patients were required to have a T2DM diagnosis (ICD-9-CM 250.x[0, 2]) and ≥12 months of continuous enrollment pre- and post-index (follow-up). Main outcome measures were adherence (proportion of days covered, PDC; medication possession ratio, MPR) and persistence on index therapy. PDC or MPR ≥0.80 was considered adherent. Patients were considered persistent until evidence of discontinuation (gap ≥90 days between two subsequent index therapy prescriptions). Kaplan-Meier (KM) analysis assessed time to discontinuation, while a Cox proportional hazards model (PHM) evaluated risk of discontinuation. Logistic regression models evaluated the likelihood of non-adherence. Results: The final sample consisted of 23, 702 patients (6, 546 CANA, 3, 087 DAPA, 6, 273 GLP-1s, and 7, 796 DPP-4s; 56% male, and mean [SD] age = 55 [9.1] years). Mean PDC ranged from 0.56 (GLP-1), to 0.71 (CANA), with 33–56% adherent, respectively; MPR results were similar. Fifty-two per cent (GLP-1) to 68% (CANA) were persistent over the follow-up. CANA patients had the longest time to discontinuation. In regression analyses, compared to CANA 100 mg, DAPA, DPP-4, and GLP-1 patients had a significantly higher likelihood of non-adherence and a significantly higher risk of discontinuation. CANA 300 mg patients had a significantly lower likelihood of non-adherence and a significantly lower risk of discontinuation compared to CANA 100 mg. Conclusions: Adherence and persistence were significantly better with CANA (100 mg and 300 mg) compared to DAPA, GLP-1s, and DPP-4s in the RW setting.