Thayer Sarah, Chow Wing, Korrer Stephanie, Aguilar Richard
a Optum , Eden Prairie , MN , USA ;
b Janssen Scientific Affairs LLC , Raritan , NJ , USA ;
Curr Med Res Opin. 2016 Jun;32(6):1087-96. doi: 10.1185/03007995.2016.1159954. Epub 2016 Mar 16.
Objective To evaluate glycemic control among patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin (CANA) vs. dipeptidyl peptidase-4 (DPP-4) inhibitors. Methods Using integrated claims and lab data from a US health plan of commercial and Medicare Advantage enrollees, this matched-control cohort study assessed adult T2DM patients receiving treatment with CANA or DPP-4 inhibitors (1 April 2013-31 December 2013). Cohorts were chosen hierarchically; the first pharmacy claim for CANA was identified as the index date; then the first pharmacy claim for a DPP-4 inhibitor was identified and index date set. Eligible patients had 6 months of continuous health plan enrollment before the index date (baseline) and 9 months after (follow-up) and no evidence of index drug in baseline. Patients were matched 1:1 using propensity score matching. Changes in glycated hemoglobin (HbA1c) and percentages of patients with HbA1c <8% and <7% during the follow-up were evaluated. Results The matched CANA and DPP-4 inhibitor cohorts (53.2% treated with sitagliptin) included 2766 patients each (mean age: 55.7 years). Among patients with baseline and follow-up HbA1c results, mean baseline HbA1c values were similar, 8.62% and 8.57% (p = 0.615) for the CANA (n = 729) and DPP-4 inhibitor (n = 710) cohorts, respectively. Change in HbA1c was greater among patients in the CANA cohort than for those in the DPP-4 inhibitor cohort (-0.92% vs. -0.63%, p < 0.001), and also among the subset of patients with baseline HbA1c ≥7% (-1.07% [n = 624] vs. -0.79% [n = 603], p = 0.004). During follow-up, greater percentages of the CANA cohort relative to the DPP-4 inhibitor cohort achieved HbA1c of <8% (66.0% vs. 58.6%, p = 0.004) and <7% (35.4% vs. 29.9%, p = 0.022). Limitations This study was observational and residual confounding remains a possibility. Conclusions In this real-world study of patients with T2DM, CANA use was associated with greater HbA1c reduction and higher percentages of patients attaining HbA1c goals than those treated with DPP-4 inhibitors.
目的 评估使用卡格列净（CANA）与二肽基肽酶-4（DPP-4）抑制剂治疗的2型糖尿病（T2DM）患者的血糖控制情况。方法 利用来自美国一个商业和医疗保险优势参保者健康计划的综合索赔和实验室数据，这项匹配对照队列研究评估了2013年4月1日至2013年12月31日期间接受CANA或DPP-4抑制剂治疗的成年T2DM患者。队列分层选取；将CANA的首张药房索赔确定为索引日期；然后确定DPP-4抑制剂的首张药房索赔并设定索引日期。符合条件的患者在索引日期（基线）前有6个月的连续健康计划参保期，之后有9个月（随访期），且基线时无索引药物使用证据。使用倾向得分匹配法将患者1:1匹配。评估随访期间糖化血红蛋白（HbA1c）的变化以及HbA1c<8%和<7%的患者百分比。结果 匹配的CANA和DPP-4抑制剂队列（53.2%接受西格列汀治疗）各包括2766例患者（平均年龄：55.7岁）。在有基线和随访HbA1c结果的患者中，CANA队列（n = 729）和DPP-4抑制剂队列（n = 710）的平均基线HbA1c值相似，分别为8.62%和8.57%（p = 0.615）。CANA队列患者的HbA1c变化大于DPP-4抑制剂队列患者（-0.92%对-0.63%，p<0.001），在基线HbA1c≥7%的患者亚组中也是如此（-1.07%[n = 624]对-0.79%[n = 603]，p = 0.004）。在随访期间，与DPP-4抑制剂队列相比，CANA队列中有更高百分比的患者HbA1c<8%（66.0%对58.6%，p = 0.004）和<7%（35.4%对29.9%，p = 0.022）。局限性 本研究为观察性研究，仍可能存在残余混杂因素。结论 在这项针对T2DM患者的真实世界研究中，与接受DPP-4抑制剂治疗的患者相比，使用CANA与更大程度的HbA1c降低以及更高百分比的患者达到HbA1c目标相关。
