a Frank Riddick Diabetes Institute , Department of Endocrinology , Ochsner Medical Center , New Orleans , LA , USA.
b IQVIA , Fairfax , VA , USA.
Curr Med Res Opin. 2018 Aug;34(8):1501-1511. doi: 10.1080/03007995.2018.1467887. Epub 2018 May 3.
To assess the impact of non-medical switch (NMS) from canagliflozin on antihyperglycemic agent (AHA) medication taking behavior.
This retrospective real-world database analysis included patients with type 2 diabetes with a prescription claim for canagliflozin (CANA) between August 2015 and January 2016 using administrative claims and longitudinal prescription data. Patients with NMS from canagliflozin were identified as those with discontinuation or switch of canagliflozin and enrolled in a pharmacy benefit manager that removed CANA from formulary in 2016. Patients with NMS were propensity score matched to patients without NMS. Patients had a 6 month baseline period and a 4 month follow-up period.
The study sample comprised 668 patients with NMS matched to 668 patients without NMS (52.4% and 49.9% male, mean age 55.6 and 55.7, respectively). Among patients with NMS, half (52.8%) did not switch to a new AHA medication (i.e. abandoned therapy) after discontinuation of CANA, while the remaining 47.2% switched to a new AHA medication. Over the 4 month follow-up, patients with NMS used significantly fewer unique AHA products compared to patients without NMS (mean [SD] 2.13 [1.40] vs. 2.66 [1.02], p < .0001). Over the 4 month follow-up, 16.5% of patients with NMS had no use of any AHA; by definition, patients without NMS used at least 1 AHA (i.e. canagliflozin).
Among patients with NMS, therapy abandonment was a major unintended consequence. Further research is needed to investigate the impact of NMS on clinical outcomes as well as the impact of NMS over a longer follow-up.
评估从卡格列净转换为非医学药物（NMS）对降糖药物（AHA）使用行为的影响。
本回顾性真实世界数据库分析纳入了 2015 年 8 月至 2016 年 1 月期间使用行政索赔和纵向处方数据有卡格列净（CANA）处方的 2 型糖尿病患者。将从卡格列净转换为 NMS 的患者定义为停止或转换卡格列净的患者，并纳入了一家药房福利管理者，该管理者在 2016 年将 CANA 从处方中删除。将 NMS 患者与无 NMS 患者进行倾向评分匹配。患者有 6 个月的基线期和 4 个月的随访期。
研究样本包括 668 名有 NMS 的患者和 668 名无 NMS 的患者（52.4%和 49.9%为男性，平均年龄分别为 55.6 和 55.7）。在 NMS 患者中，一半（52.8%）在停止使用 CANA 后没有换用新的 AHA 药物（即放弃治疗），而其余 47.2%换用了新的 AHA 药物。在 4 个月的随访期间，NMS 患者使用的 AHA 药物明显少于无 NMS 患者（平均[标准差]2.13[1.40]比 2.66[1.02]，p<.0001）。在 4 个月的随访期间，有 16.5%的 NMS 患者没有使用任何 AHA 药物；根据定义，无 NMS 患者至少使用了 1 种 AHA 药物（即卡格列净）。
在 NMS 患者中，治疗中断是一个主要的意外后果。需要进一步研究 NMS 对临床结局的影响，以及更长时间随访时 NMS 的影响。
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