Cai Jennifer, Divino Victoria, Burudpakdee Chakkarin
a Janssen Scientific Affairs, LLC , Titusville , NJ , USA.
b QuintilesIMS , Fairfax , VA , USA.
Curr Med Res Opin. 2017 Jul;33(7):1317-1328. doi: 10.1080/03007995.2017.1320277. Epub 2017 May 8.
Sodium-glucose co-transporter 2 inhibitors were first approved in the US in 2013; therefore, real-world (RW) studies describing outcomes are limited. This retrospective study evaluated adherence and persistence among patients initiating canagliflozin (CANA), dapagliflozin (DAPA), GLP-1 agonists (GLP-1s), and DPP-4 inhibitors (DPP-4s) over a 12-month follow-up from a US managed care perspective.
Patients newly initiating CANA, DAPA, GLP-1s, or DPP-4s from February 1, 2014-June 30, 2014 were identified from the QuintilesIMS PharMetrics Plus Database. The first fill defined the index date/drug. Patients were required to have a T2DM diagnosis (ICD-9-CM 250.x[0,2]) and ≥12 months of continuous enrollment pre- and post-index (follow-up). Main outcome measures were adherence (proportion of days covered, PDC; medication possession ratio, MPR) and persistence on index therapy. PDC or MPR ≥0.80 was considered adherent. Patients were considered persistent until evidence of discontinuation (gap ≥90 days between two subsequent index therapy prescriptions). Kaplan-Meier (KM) analysis assessed time to discontinuation, while a Cox proportional hazards model (PHM) evaluated risk of discontinuation. Logistic regression models evaluated the likelihood of non-adherence.
The final sample consisted of 23,702 patients (6,546 CANA, 3,087 DAPA, 6,273 GLP-1s, and 7,796 DPP-4s; 56% male, and mean [SD] age = 55 [9.1] years). Mean PDC ranged from 0.56 (GLP-1), to 0.71 (CANA), with 33-56% adherent, respectively; MPR results were similar. Fifty-two per cent (GLP-1) to 68% (CANA) were persistent over the follow-up. CANA patients had the longest time to discontinuation. In regression analyses, compared to CANA 100 mg, DAPA, DPP-4, and GLP-1 patients had a significantly higher likelihood of non-adherence and a significantly higher risk of discontinuation. CANA 300 mg patients had a significantly lower likelihood of non-adherence and a significantly lower risk of discontinuation compared to CANA 100 mg.
Adherence and persistence were significantly better with CANA (100 mg and 300 mg) compared to DAPA, GLP-1s, and DPP-4s in the RW setting.
钠-葡萄糖协同转运蛋白2抑制剂于2013年在美国首次获批；因此，描述其疗效的真实世界（RW）研究有限。本回顾性研究从美国管理式医疗的角度，评估了在12个月的随访期内，起始使用卡格列净（CANA）、达格列净（DAPA）、胰高血糖素样肽-1激动剂（GLP-1s）和二肽基肽酶-4抑制剂（DPP-4s）的患者的依从性和持续性。
从昆泰IMS PharMetrics Plus数据库中识别出2014年2月1日至2014年6月30日期间新起始使用CANA、DAPA、GLP-1s或DPP-4s的患者。首次配药确定为索引日期/药物。患者需确诊为2型糖尿病（ICD-9-CM 250.x[0,2]），且在索引前后连续入组≥12个月（随访）。主要结局指标为依从性（覆盖天数比例，PDC；药物持有率，MPR）和索引治疗的持续性。PDC或MPR≥0.80被视为依从。在有停药证据（两次后续索引治疗处方之间的间隔≥90天）之前，患者被视为持续用药。Kaplan-Meier（KM）分析评估停药时间，而Cox比例风险模型（PHM）评估停药风险。逻辑回归模型评估不依从的可能性。
最终样本包括23702名患者（6546名使用CANA，3087名使用DAPA，6273名使用GLP-1s，7796名使用DPP-4s；56%为男性，平均[标准差]年龄 = 55[9.1]岁）。平均PDC范围从0.56（GLP-1）到0.71（CANA），依从率分别为33% - 56%；MPR结果相似。在随访期间，52%（GLP-1）至68%（CANA）的患者持续用药。使用CANA的患者停药时间最长。在回归分析中，与100mg的CANA相比，使用DAPA、DPP-4和GLP-1的患者不依从的可能性显著更高，停药风险也显著更高。与100mg的CANA相比，300mg的CANA患者不依从的可能性显著更低，停药风险也显著更低。
在真实世界环境中，与DAPA、GLP-1s和DPP-4s相比，CANA（100mg和300mg）的依从性和持续性显著更好。
