Ahuja Vishal, Chou Chia-Hung
Cox School of Business, Southern Methodist University, PO Box 750333, Dallas, TX, 75275, USA.
Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
Curr Diab Rep. 2016 Jun;16(6):47. doi: 10.1007/s11892-016-0744-4.
The number of available therapies for treating type 2 diabetes has grown considerably in recent years. This growth has been fueled by availability of newer medications, whose benefits and risks have not been fully established. In this study, we review and synthesize the existing literature on the uptake, efficacy, safety, and cost-effectiveness of novel antidiabetic agents. Specifically, we focus on three drug classes that were introduced in the market recently: thiazolidinediones (TZDs), dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists. Not surprisingly, we find that the usage trends reflect the efficacy and safety profile of these novel drugs. The use of TZDs increased initially but decreased after a black-box warning was issued for rosiglitazone in 2007 that highlighted the cardiovascular risks associated with using the drug. Conversely, DPP-4 inhibitors and GLP-1 receptor agonists gained market shares due to their efficacy in glycemic control as an add-on treatment to metformin. DPP-4 inhibitors were the most commonly prescribed agents among the three novel drug classes, likely because they are relatively less expensive, have better safety profile, are administered orally, and are weight neutral. Sitagliptin was the most preferred DPP-4 inhibitor. The level of evidence on the comparative effectiveness, safety, and cost implications of using novel antidiabetic agents remains low and further studies with long-term follow-ups are needed.
近年来，用于治疗2型糖尿病的可用疗法数量大幅增加。这一增长得益于新型药物的出现，但其益处和风险尚未完全明确。在本研究中，我们回顾并综合了关于新型抗糖尿病药物的采用情况、疗效、安全性和成本效益的现有文献。具体而言，我们重点关注最近进入市场的三类药物：噻唑烷二酮类（TZDs）、二肽基肽酶-4（DPP-4）抑制剂和胰高血糖素样肽-1（GLP-1）受体激动剂。不出所料，我们发现使用趋势反映了这些新药的疗效和安全性概况。TZDs的使用最初有所增加，但在2007年罗格列酮被发出黑框警告，强调使用该药物的心血管风险后，其使用量下降。相反，DPP-4抑制剂和GLP-1受体激动剂因其作为二甲双胍附加治疗在血糖控制方面的疗效而获得了市场份额。DPP-4抑制剂是这三类新药中最常被处方的药物，可能是因为它们相对便宜、安全性更好、口服给药且对体重无影响。西他列汀是最受青睐的DPP-4抑制剂。关于使用新型抗糖尿病药物的比较有效性、安全性和成本影响的证据水平仍然较低，需要进行进一步的长期随访研究。
