US adults with type 2 diabetes who initiated DPP-4 inhibitors had significantly greater odds of 1-year adherence compared to those initiating sulfonylureas (AOR 1.678) or thiazolidinediones.
Cohort (n=238,372)
Do DPP-4 inhibitors improve medication adherence and persistence compared to sulfonylureas or thiazolidinediones in adults with type 2 diabetes mellitus?
Initiation of DPP-4 inhibitors, particularly saxagliptin, is associated with significantly better long-term adherence and persistence compared to sulfonylureas or thiazolidinediones in US adults with type 2 diabetes.
Odds Ratio: 1.678 (95% CI 1.631–1.727)
Tasa de eventos absoluta: 47.3% vs 41.2%
valor p: p=<0.001
INTRODUCTION: Patients with type 2 diabetes mellitus (T2DM) must remain adherent and persistent on antidiabetic medications to optimize clinical benefits. This analysis compared adherence and persistence among adults initiating dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), and thiazolidinediones (TZDs) and between patients initiating saxagliptin or sitagliptin, two DPP-4is. METHODS: This retrospective cohort study utilized the US MarketScan(®) (Truven Health Analytics, Ann Arbor, MI, USA) Commercial and Medicare Supplemental health insurance claims databases. Adults aged ≥18 years with T2DM who initiated a DPP-4i, SU, or TZD from January 1, 2009 to January 31, 2012 were included. Patients must have been continuously enrolled for ≥1 year prior to and ≥1 year following initiation. Adherence was measured using proportion of days covered (PDC), with PDC ≥ 0.80 considered adherent. Persistence was measured as time to discontinuation, defined as last day with drug prior to a 60+ days gap in therapy. Multivariable logistic regression and Cox proportional hazards models compared the outcomes between cohorts, controlling for baseline differences. RESULTS: The sample included 238,372 patients (61,399 DPP-4i, 134,961 SU, 42,012 TZD). During 1-year follow-up, 47.3% of DPP-4i initiators, 41.2% of SU initiators, and 36.7% of TZD initiators were adherent. Adjusted odds of adherence were significantly greater among DPP-4i initiators than SU (adjusted odds ratio AOR = 1.678, P < 0.001) and TZD initiators (AOR = 1.605, P < 0.001). During 1-year follow-up, 55.0% of DPP-4i initiators, 47.8% of SU initiators, and 42.9% of TZD initiators did not discontinue therapy. Adjusted hazards of discontinuation were significantly greater for SU (adjusted hazard ratio AHR = 1.390, P < 0.001) and TZD initiators (AHR = 1.402, P < 0.001) compared with DPP-4i initiators. Saxagliptin initiators had significantly better adherence (AOR = 1.213, P < 0.001) compared with sitagliptin initiators, and sitagliptin initiators had significantly greater hazard of discontinuation (AHR = 1.159, P < 0.001). Results were similar over a 2-year follow-up. CONCLUSIONS: US adults with T2DM who initiated DPP-4i therapy, particularly saxagliptin, had significantly better adherence and persistence compared with patients who initiated SUs or TZDs.
Farr et al. (Mon,) conducted a cohort in Type 2 Diabetes Mellitus (n=238,372). Dipeptidyl peptidase-4 inhibitors (DPP-4is) vs. Sulfonylureas (SUs) and thiazolidinediones (TZDs) was evaluated on Adherence (proportion of days covered ≥ 0.80) at 1 year (AOR 1.678, 95% CI 1.631-1.727, p=<0.001). US adults with type 2 diabetes who initiated DPP-4 inhibitors had significantly greater odds of 1-year adherence compared to those initiating sulfonylureas (AOR 1.678) or thiazolidinediones.