美国新型抗高血糖药物治疗2型糖尿病患者的持续用药情况及依从性比较
Comparative persistence and adherence with newer anti-hyperglycemic agents to treat patients with type 2 diabetes in the United States.
作者信息
Cai Jennifer, Wang Yuexi, Baser Onur, Xie Lin, Chow Wing
机构信息
a Janssen Scientific Affairs, LLC , Raritan , NJ , USA.
b STATinMED Research , Ann Arbor , MI , USA.
出版信息
J Med Econ. 2016 Dec;19(12):1175-1186. doi: 10.1080/13696998.2016.1208208. Epub 2016 Jul 12.
OBJECTIVES
Non-adherence and non-persistence to anti-hyperglycemic agents are associated with worse clinical and economic outcomes in patients with type 2 diabetes. This study evaluated treatment persistence and adherence across newer anti-hyperglycemic agents (canagliflozin, dapagliflozin, sitagliptin, saxagliptin, linagliptin, liraglutide, or exenatide).
METHODS
This retrospective cohort study of Truven Health Analytics Marketscan databases included adult patients with type 2 diabetes whose first pharmacy claim for a newer anti-hyperglycemic agent was between February 1, 2014 and July 31, 2014. Treatment persistence and adherence were assessed for 12 months after the first claim (post-index). Persistence was defined as no gap ≥90 days between the end of one pharmacy claim and the start of the next pharmacy claim post-index. Adherence used two definitions: proportion of days covered (PDC) and medication possession ratio (MPR). Multivariable analyses of non-persistence (hazard ratios) and adherence (odds ratios) were adjusted for baseline demographics, drug cost, clinical characteristics, and other anti-hyperglycemic agents.
RESULTS
A total of 11,961 patients met all study selection criteria. Persistence rates at 12 months were significantly greater (p < 0.05 for each comparison) for canagliflozin 100 mg (61%) compared with dapagliflozin 5 mg (40%), dapagliflozin 10 mg (41%), sitagliptin (48%), saxagliptin (42%), linagliptin (52%), liraglutide (47%), exenatide (23%), and long-acting exenatide (39%). The persistence rate was greater (p < 0.05) for canagliflozin 300 mg (64%) vs canagliflozin 100 mg. Median adherence rates for canagliflozin 100 mg (MPR = 0.83; PDC = 0.79) and canagliflozin 300 mg (MPR = 0.92; PDC = 0.81) were greater than for the other index anti-hyperglycemic agents (MPR = 0.33-0.75; PDC = 0.33-0.72). Consistent results for treatment persistence and adherence were observed in multivariable analyses that were adjusted baseline characteristics.
CONCLUSIONS
Canagliflozin was associated with better treatment persistence and treatment adherence compared with other anti-hyperglycemic agents in real-world settings.
目的
2型糖尿病患者对抗血糖药物的不依从和不持续使用与更差的临床和经济结局相关。本研究评估了新型抗血糖药物（卡格列净、达格列净、西他列汀、沙格列汀、利奈格列汀、利拉鲁肽或艾塞那肽）的治疗持续性和依从性。
方法
这项对Truven Health Analytics Marketscan数据库的回顾性队列研究纳入了2型糖尿病成年患者，其首次药房申领新型抗血糖药物的时间在2014年2月1日至2014年7月31日之间。在首次申领（索引后）后的12个月评估治疗持续性和依从性。持续性定义为索引后一次药房申领结束与下一次药房申领开始之间无≥90天的间隔。依从性采用两个定义：覆盖天数比例（PDC）和药物持有率（MPR）。对不持续性（风险比）和依从性（比值比）进行多变量分析，并针对基线人口统计学、药物成本、临床特征和其他抗血糖药物进行调整。
结果
共有11961名患者符合所有研究入选标准。卡格列净100mg在12个月时的持续性率显著更高（每次比较p<0.05），分别为61%，相比之下，达格列净5mg为40%，达格列净10mg为41%，西他列汀为48%，沙格列汀为42%，利奈格列汀为52%，利拉鲁肽为47%，艾塞那肽为23%，长效艾塞那肽为39%。卡格列净300mg的持续性率（64%）高于卡格列净100mg（p<0.05）。卡格列净100mg（MPR = 0.83；PDC = 0.79）和卡格列净300mg（MPR = 0.92；PDC = 0.81）的中位依从率高于其他索引抗血糖药物（MPR = 0.33 - 0.75；PDC = 0.33 - 0.72）。在调整了基线特征的多变量分析中观察到治疗持续性和依从性的一致结果。
结论
在现实环境中，与其他抗血糖药物相比，卡格列净与更好的治疗持续性和治疗依从性相关。
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