Seong Jong-Mi, Kim Jong Joo, Kim Hae Jin, Sohn Hyun Soon
Research Institute for Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea.
Pharmaceutical Information Research Institute, CHA University, Seongnam, South Korea.
Front Pharmacol. 2021 Sep 28;12:689885. doi: 10.3389/fphar.2021.689885. eCollection 2021.
This study compared dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, and dipeptidyl peptidase-4 inhibitors (DPP-4i) with regard to cardiovascular (CV) event incidence and direct medical costs during type 2 diabetes treatment. A retrospective cohort study was conducted using national health insurance claims data from September 1, 2014, to June 30, 2018, of patients in Korea. Patients who were prescribed dapagliflozin and DPP-4i for the first time were included. The primary outcome was the incidence of a composite of major adverse CV events (MACEs)-nonfatal myocardial infarction, nonfatal stroke, or in-hospital CV death. Proportional hazard models after propensity score weighting were used to determine hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE in the dapagliflozin and DPP-4i groups. A decision analytic model was used to compare direct medical costs between the two treatment groups from a healthcare provider's perspective. Of the 260,336 patients in the cohort, 23,147 and 237,189 received dapagliflozin and DPP-4i, respectively. During the follow-up, 184 patients receiving dapagliflozin and 3,674 receiving DPP-4i (incidence, 6.47 and 11.33 events/1,000 person-years, respectively) had MACE. The adjusted HR of MACE for dapagliflozin compared with that for DPP-4i was 0.69 (95% CI 0.57-0.83). The corresponding HRs were consistent among patients with and without underlying CV disease. The estimated direct medical cost appeared to be lower by $68,452 in the dapagliflozin group than that in the DPP-4i group for 3 years, in 1,000 hypothetical patients. In this population-based cohort study, the use of dapagliflozin instead of DPP-4i was associated with a reduced risk of MACE, which subsequently reduced direct medical costs. These data provide valuable information to patients, practitioners, and authorities regarding the risk of CV events associated with dapagliflozin versus DPP-4i use in clinical practice.
本研究比较了钠-葡萄糖协同转运蛋白2抑制剂达格列净与二肽基肽酶-4抑制剂（DPP-4i）在2型糖尿病治疗期间的心血管（CV）事件发生率和直接医疗费用。利用韩国2014年9月1日至2018年6月30日的国民健康保险理赔数据进行了一项回顾性队列研究。纳入首次处方达格列净和DPP-4i的患者。主要结局是主要不良心血管事件（MACE）的复合发生率，包括非致命性心肌梗死、非致命性中风或住院期间CV死亡。使用倾向评分加权后的比例风险模型来确定达格列净组和DPP-4i组中MACE的风险比（HR）和95%置信区间（CI）。使用决策分析模型从医疗服务提供者的角度比较两个治疗组之间的直接医疗费用。队列中的260336名患者中，分别有23147名和237189名接受了达格列净和DPP-4i治疗。在随访期间，184名接受达格列净治疗的患者和3674名接受DPP-4i治疗的患者（发生率分别为6.47和11.33事件/1000人年）发生了MACE。达格列净与DPP-4i相比，MACE的校正HR为0.69（95%CI 0.57-0.83）。在有和无潜在CV疾病的患者中，相应的HR一致。在1000名假设患者中，达格列净组3年的估计直接医疗费用似乎比DPP-4i组低68452美元。在这项基于人群的队列研究中，使用达格列净而非DPP-4i与MACE风险降低相关，这随后降低了直接医疗费用。这些数据为患者、从业者和当局提供了关于临床实践中使用达格列净与DPP-4i相关的CV事件风险的有价值信息。
