Farr Amanda M, Sheehan John J, Curkendall Suellen M, Smith David M, Johnston Stephen S, Kalsekar Iftekhar
Truven Health Analytics, 7700 Old Georgetown Road, 6th Floor, Bethesda, MD, 20814, USA,
Adv Ther. 2014 Dec;31(12):1287-305. doi: 10.1007/s12325-014-0171-3. Epub 2014 Dec 12.
Patients with type 2 diabetes mellitus (T2DM) must remain adherent and persistent on antidiabetic medications to optimize clinical benefits. This analysis compared adherence and persistence among adults initiating dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), and thiazolidinediones (TZDs) and between patients initiating saxagliptin or sitagliptin, two DPP-4is.
This retrospective cohort study utilized the US MarketScan(®) (Truven Health Analytics, Ann Arbor, MI, USA) Commercial and Medicare Supplemental health insurance claims databases. Adults aged ≥18 years with T2DM who initiated a DPP-4i, SU, or TZD from January 1, 2009 to January 31, 2012 were included. Patients must have been continuously enrolled for ≥1 year prior to and ≥1 year following initiation. Adherence was measured using proportion of days covered (PDC), with PDC ≥ 0.80 considered adherent. Persistence was measured as time to discontinuation, defined as last day with drug prior to a 60+ days gap in therapy. Multivariable logistic regression and Cox proportional hazards models compared the outcomes between cohorts, controlling for baseline differences.
The sample included 238,372 patients (61,399 DPP-4i, 134,961 SU, 42,012 TZD). During 1-year follow-up, 47.3% of DPP-4i initiators, 41.2% of SU initiators, and 36.7% of TZD initiators were adherent. Adjusted odds of adherence were significantly greater among DPP-4i initiators than SU (adjusted odds ratio [AOR] = 1.678, P < 0.001) and TZD initiators (AOR = 1.605, P < 0.001). During 1-year follow-up, 55.0% of DPP-4i initiators, 47.8% of SU initiators, and 42.9% of TZD initiators did not discontinue therapy. Adjusted hazards of discontinuation were significantly greater for SU (adjusted hazard ratio [AHR] = 1.390, P < 0.001) and TZD initiators (AHR = 1.402, P < 0.001) compared with DPP-4i initiators. Saxagliptin initiators had significantly better adherence (AOR = 1.213, P < 0.001) compared with sitagliptin initiators, and sitagliptin initiators had significantly greater hazard of discontinuation (AHR = 1.159, P < 0.001). Results were similar over a 2-year follow-up.
US adults with T2DM who initiated DPP-4i therapy, particularly saxagliptin, had significantly better adherence and persistence compared with patients who initiated SUs or TZDs.
2型糖尿病（T2DM）患者必须持续坚持服用抗糖尿病药物，以优化临床疗效。本分析比较了起始使用二肽基肽酶-4抑制剂（DPP-4i）、磺脲类药物（SUs）和噻唑烷二酮类药物（TZDs）的成年人之间的依从性和持续性，以及起始使用两种DPP-4i（沙格列汀或西格列汀）的患者之间的依从性和持续性。
这项回顾性队列研究使用了美国MarketScan®（Truven Health Analytics公司，美国密歇根州安娜堡）商业和医疗保险补充健康保险理赔数据库。纳入了2009年1月1日至2012年1月31日期间起始使用DPP-4i、SU或TZD的年龄≥18岁的T2DM成年人。患者在起始治疗前必须连续参保≥1年，起始治疗后也必须连续参保≥1年。使用覆盖天数比例（PDC）来衡量依从性，PDC≥0.80被视为依从。持续性以停药时间来衡量，定义为治疗间隔60天以上之前的最后用药日。多变量逻辑回归和Cox比例风险模型比较了各队列之间的结果，并控制了基线差异。
样本包括238,372名患者（61,399名使用DPP-4i，134,961名使用SU，42,012名使用TZD）。在1年的随访期间，47.3%的DPP-4i起始使用者、41.2%的SU起始使用者和36.7%的TZD起始使用者依从治疗。DPP-4i起始使用者的调整后依从几率显著高于SU起始使用者（调整后优势比[AOR]=1.678，P<0.001）和TZD起始使用者（AOR=1.605，P<0.001）。在1年的随访期间，55.0%的DPP-4i起始使用者、47.8%的SU起始使用者和42.9%的TZD起始使用者未停药。与DPP-4i起始使用者相比，SU起始使用者（调整后风险比[AHR]=1.390，P<0.001）和TZD起始使用者（AHR=1.402，P<0.001）的调整后停药风险显著更高。与西格列汀起始使用者相比，沙格列汀起始使用者的依从性显著更好（AOR=1.213，P<0.001），而西格列汀起始使用者的停药风险显著更高（AHR=1.159，P<0.001）。在2年的随访中结果相似。
与起始使用SU或TZD的患者相比，起始接受DPP-4i治疗，尤其是沙格列汀治疗的美国T2DM成年人的依从性和持续性显著更好。
