Laires Pedro A, Tang Jackson, Fan Chun Po Steve, Li Zhiyi, Qiu Ying, Iglay Kristy
a Outcomes Research , MSD Portugal , Paço de Arcos , Portugal.
b Asclepius Analytics Ltd , Wan Chai , Hong Kong.
Expert Rev Pharmacoecon Outcomes Res. 2017 Apr;17(2):213-220. doi: 10.1080/14737167.2016.1203259. Epub 2016 Jun 30.
A retrospective cohort study using GE Centricity electronic medical records assessed the association between post-index hypoglycemia and HbA1c with discontinuation and down-titration of sulfonylureas among patients with Type 2 diabetes mellitus.
Adult patients with an index prescription for a sulfonylurea and ≥12 months' continuous records pre- and post-index were eligible. Sulfonylurea discontinuation and down-titration was assessed 1-year post-index. Discontinuation occurred if the date of a prescription was >90 days from the preceding prescription plus days of supply. Down-titration occurred when a subsequent prescription was lower than the index dose. Cox regression assessed the association between post-index hypoglycemia and HbA1c with time to sulfonylurea discontinuation and down-titration, as well as other factors.
28,371 participants were included in the study; 13,459 (47.4%) were discontinuers, 717 (2.5%) were down-titraters, and 14,195 (50.0%) were continuers. 0.6% of continuers experienced hypoglycemia 1-year post-index, compared with 3.1% of down-titraters and 0.8% of discontinuers (p < 0.0001). Patients with post-index hypoglycemia had a significantly higher rate of discontinuation (hazard ratio [HR] = 1.82, 95% CI: 1.47-2.23) and down-titration (HR = 4.25, 95% CI: 1.92-8.03). Patients with higher post-index HbA1c and use of 2 generation sulfonylureas had an increased rate of discontinuation (HR = 1.05, 95% CI: 1.04-1.06; HR = 1.19, 95% CI: 1.14-1.24, respectively).
Approximately half of participants who initiated sulfonylureas discontinued or down-titrated therapy within one year. Both post-index hypoglycemia and higher HbA1c were significant risk factors for sulfonylurea treatment change.
一项使用GE Centricity电子病历的回顾性队列研究评估了2型糖尿病患者索引后低血糖和糖化血红蛋白（HbA1c）与磺脲类药物停药及减量之间的关联。
纳入有磺脲类药物索引处方且索引前后有≥12个月连续记录的成年患者。在索引后1年评估磺脲类药物的停药和减量情况。如果处方日期距离前一张处方加上供应天数>90天，则视为停药。当后续处方剂量低于索引剂量时，则视为减量。Cox回归评估索引后低血糖和HbA1c与磺脲类药物停药和减量时间以及其他因素之间的关联。
28371名参与者纳入研究；13459名（47.4%）为停药者，717名（2.5%）为减量者，14195名（50.0%）为持续使用者。索引后1年，0.6%的持续使用者发生低血糖，相比之下，减量者为3.1%，停药者为0.8%（p<0.0001）。索引后发生低血糖的患者停药率（风险比[HR]=1.82，95%置信区间：1.47-2.23）和减量率（HR=4.25，95%置信区间：1.92-8.03）显著更高。索引后HbA1c较高且使用第二代磺脲类药物的患者停药率增加（HR分别为1.05，95%置信区间：1.04-1.06；HR为1.19，95%置信区间：1.14-1.24）。
开始使用磺脲类药物的参与者中约有一半在1年内停药或减量治疗。索引后低血糖和较高的HbA1c都是磺脲类药物治疗改变的重要危险因素。
