Malik Mariam Elmegaard, Falkentoft Alexander Christian, Jensen Jesper, Zahir Deewa, Parveen Saaima, Alhakak Amna, Andersson Charlotte, Petrie Mark C, Sattar Naveed, McMurray John J V, Køber Lars, Schou Morten
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark.
Department of Cardiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
Lancet Reg Health Eur. 2023 Mar 17;29:100617. doi: 10.1016/j.lanepe.2023.100617. eCollection 2023 Jun.
Small observational studies have observed poor persistency to sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucacon-like-peptide-1-receptor agonists (GLP1-RA), contrary to what has been reported in clinical trials. Therefore, we investigated the risk of discontinuing SGLT2-is and GLP1-RAs in patients with type 2 diabetes (T2D) in a nationwide population.
From Danish nationwide registers, all first-time users of SGLT2-is and GLP1-RAs from 2013 to 2021 were identified. Adherence over the first year of therapy, the five-year risk of discontinuing therapy for the first time and the subsequent one-year probability of reinitiating therapy, was assessed. The Aalen-Johansen estimator was used to account for censoring and competing risks and multivariable Cox regression models were used to identify covariates associated with discontinuation.
A total of 77,745 first-time users of SGLT2-is (64% male, median age 64 [interquartile range 56-72]) and 56,037 first-time users of GLP1-RAs (56% male, median age 61 [53-70]) were included. The absolute five-year risk of discontinuing therapy was 56% (95% CI: 55-57) and 45% (45-46) for SGLT2-i- and GLP1-RA users, respectively, with a significantly decreased risk over the period studied. The subsequent one-year probability of reinitiating therapy was 24% (95% CI: 24-25) for initial SGLT2-i users and 26% (25-27) for GLP1-RA users.
Approximately half of the users of SGLT2-is and GLP1-RAs discontinued therapy within five years, respectively. However, a large proportion of these patients reinitiated therapy during the following year. Further insight into the reasons for discontinuation and initiatives to reduce the time to reinitiation in eligible patients are warranted.
The work was funded by an unrestricted research grant from 'Department of Cardiology, Herlev and Gentofte University Hospital'.
小型观察性研究发现，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2-i）和胰高血糖素样肽-1受体激动剂（GLP1-RA）的持续性较差，这与临床试验中的报告结果相反。因此，我们在全国范围内调查了2型糖尿病（T2D）患者停用SGLT2-i和GLP1-RA的风险。
从丹麦全国登记处识别出2013年至2021年期间所有首次使用SGLT2-i和GLP1-RA的患者。评估了治疗第一年的依从性、首次停药的五年风险以及随后重新开始治疗的一年概率。使用Aalen-Johansen估计量来处理删失和竞争风险，并使用多变量Cox回归模型来识别与停药相关的协变量。
共纳入77745名首次使用SGLT2-i的患者（64%为男性，中位年龄64岁[四分位间距56 - 72岁]）和56037名首次使用GLP1-RA的患者（56%为男性，中位年龄61岁[53 - 70岁]）。SGLT2-i和GLP1-RA使用者停药的绝对五年风险分别为56%（95%置信区间：55 - 57）和45%（45 - 46），在研究期间风险显著降低。初始SGLT2-i使用者随后重新开始治疗的一年概率为24%（95%置信区间：24 -
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