Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.
Ospedale di Pordenone - Azienda per l'Assistenza Sanitaria n.5, Friuli Occidentale, 33170, Pordenone, Italy.
J Endocrinol Invest. 2020 Mar;43(3):329-336. doi: 10.1007/s40618-019-01110-w. Epub 2019 Sep 12.
In routine clinical practice, early discontinuation of newly initiated glucose-lowering medications (GLM) is relatively common. We herein evaluated if the clinical characteristics associated with early discontinuation of dapagliflozin were different from those associated with early discontinuation of other GLM.
The DARWIN-T2D was a multicenter retrospective study conducted at diabetes specialist outpatient clinics in Italy. We included 2484 patients who were initiated on dapagliflozin in 2015-2016 and 14,801 patients who were initiated on other GLM (DPP-4 inhibitors, GLP-1 receptor agonists, or gliclazide) in the same period. After excluding patients who had not (yet) returned to follow-up, we compared the characteristics of patients who persisted on drug versus those who were no longer on drug at the first available follow-up after at least 3 months.
As compared to those who persisted on drug, patients who discontinued dapagliflozin (51.7%) were more often female, had higher baseline fasting plasma glucose (FPG), HbA1c, and eGFR, and less common use of metformin. Upon multiple regression, higher HbA1c, higher eGFR, and lower metformin use remained independently associated with early discontinuation. Among patients who had been initiated on other GLM, 41.7% discontinued. Variables independently associated with discontinuation were older age, longer diabetes duration, higher HbA1c, eGFR, and albumin excretion, more common use of insulin and less metformin.
In routine clinical practice, all variables associated with dapagliflozin discontinuation were also associated with discontinuation of other GLM. Thus, despite a distinctive mechanism of action and a peculiar tolerability profile, no specific predictor of dapagliflozin discontinuation was detected.
在常规临床实践中，新启动的降糖药物（GLM）的早期停药较为常见。本研究旨在评估与达格列净早期停药相关的临床特征是否与其他 GLM 早期停药相关的临床特征不同。
DARWIN-T2D 是一项在意大利糖尿病专科门诊进行的多中心回顾性研究。我们纳入了 2015-2016 年期间新开始使用达格列净的 2484 例患者和同期新开始使用其他 GLM（DPP-4 抑制剂、GLP-1 受体激动剂或格列齐特）的 14801 例患者。在排除尚未（尚未）返回随访的患者后，我们比较了在至少 3 个月后首次可获得随访时仍在用药的患者和不再用药的患者的特征。
与仍在用药的患者相比，停药的达格列净患者（51.7%）更多为女性，基线空腹血糖（FPG）、HbA1c 和 eGFR 更高，且更常见不使用二甲双胍。多变量回归分析显示，较高的 HbA1c、较高的 eGFR 和较低的二甲双胍使用率与早期停药独立相关。在新开始使用其他 GLM 的患者中，有 41.7%停药。与停药相关的独立变量为年龄较大、糖尿病病程较长、HbA1c、eGFR 和白蛋白排泄较高、更常见使用胰岛素和较少使用二甲双胍。
在常规临床实践中，与达格列净停药相关的所有变量也与其他 GLM 的停药相关。因此，尽管作用机制独特且耐受性良好，但并未发现达格列净停药的特定预测因素。
