Cardiac Renal and Vascular Associates PC, Jackson, MS, USA.
Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK.
Acta Diabetol. 2021 Jan;58(1):39-46. doi: 10.1007/s00592-020-01590-w. Epub 2020 Aug 18.
Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors.
MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed.
Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3-64.4) at one year and 44.2% (95% CI 36.4-52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5-79.5) at six months to 52.8% (95% CI 51.6-59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1-3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest.
Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.
药物依从性和持久性是 2 型糖尿病（T2DM）治疗成功的重要决定因素。本系统评价和荟萃分析评估了处方二肽基肽酶-4（DPP4）抑制剂的 T2DM 患者的真实世界依从性、持久性和同类药物转换。
检索 MEDLINE、EMBASE、Cochrane 图书馆、PsycINFO 和 CINAHL 数据库，以获取截至 2019 年 12 月 20 日发表的关于二肽基肽酶-4（DPP4）抑制剂的相关观察性研究，补充纳入文献的参考文献的手动筛选。采用随机效应荟萃分析。
纳入了来自十个国家的 34 项队列研究，共涉及 594138 例 T2DM 患者，处方 DPP4 抑制剂。一年时的依从率（覆盖天数（PDC）或用药率（MPR）≥0.80）为 56.9%（95%置信区间[CI] 49.3-64.4），两年时为 44.2%（95% CI 36.4-52.1）。治疗的持续率从 6 个月时的 75.6%（95% CI 71.5-79.5）下降到 2 年时的 52.8%（95% CI 51.6-59.8）。个别 DPP4 抑制剂之间的依从性和持久性没有显著差异。一年时，只有 3.2%（95% CI 3.1-3.3）的患者从一种 DPP4 抑制剂转换为另一种。从沙格列汀和阿格列汀转换为其他药物最常见。
DPP4 抑制剂的依从性和持久性不理想，但在该类药物中所有药物之间相似。虽然同类药物转换不常见，但沙格列汀和阿格列汀是最常转换的 DPP4 抑制剂。可能需要干预措施来提高服用 DPP4 抑制剂的 T2DM 患者的治疗依从性和持久性。
