Comparison of persistence and adherence between fixed-dose combinations and two-pill combinations in Japanese patients with type 2 diabetes

Abstract

Objective: To compare treatment patterns, persistence and adherence between fixed-dose combinations (FDCs) and two-pill combinations (TPCs) of oral antidiabetic drug (OAD) classes in Japanese patients with type 2 diabetes mellitus (T2DM) using administrative claims databases (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV]). Methods: This was a retrospective, longitudinal cohort analysis conducted between 2011 and 2015, in patients with T2DM receiving OADs as FDC or TPC. Outcomes included prescribing patterns, treatment persistence and adherence. Results: Data from 3474 and 3066 patients receiving FDCs, and 4325 and 5192 patients receiving TPCs from the JMDC and MDV databases, respectively, was extracted. The most common OAD combination received by over half of all patients was dipeptidyl peptidase-4 inhibitor (DPP-4i) þ thiazolidinediones (TZDs) (64.1% [JMDC] and 70.5% [MDV]). Overall, 12-month persistence rates were higher in patients receiving FDCs compared with TPCs (70.4 vs. 66.2% [JMDC], 75.6 vs. 55.7% [MDV]). In the JMDC population receiving FDCs or TPCs, persistence rates were highest with DPP-4i schedules (67.5-83.5%). Median time to discontinuation was significantly longer with biguanide þ TZD, and DPP-4i þ TZD FDC schedules (p < .05) than TPC; adherence rates were 80% across all antidiabetic drug classes in both database populations. Conclusions: Persistence with and adherence to OADs in Japanese patients with T2DM were greater with FDCs than with TPCs, which may suggest increased patient satisfaction due to reduced treatment burden. Further studies are warranted to investigate the impact of adherence and persistence of FDCs of OADs on glycemic control.

Long‐term clinical outcomes of oral antidiabetic drugs as fixed‐dose combinations: A nationwide retrospective cohort study

“…Our findings are generally consistent with those of previous studies that showed a positive association between FDC therapy and adherence and persistence 11,12,21‐24 . A meta‐analysis conducted by Bangalore et al revealed that FDC therapy improved medication non‐compliance by 26% (pooled relative risk, 0.74; 95% CI 0.69‐0.80; P < .0001) when compared with a free‐drug combination 21 .…”

Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes

“…With one exception from Greece [ 19 ], there is little evidence on outcomes in European health care markets, which differ considerably from the US health care sector, e.g., with respect to drug reimbursement policies that may affect medication adherence. A further weakness of most of the previous studies is their short follow-up period of no more than 12 months [ 11 – 17 , 19 , 20 ]. Literature on medication compliance suggests that long-term compliance is more difficult to obtain than short-term compliance and requires a combination of interventions to be effective [ 21 ].…”

Comparison of persistence and adherence between DPP-4 inhibitor administration frequencies in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study

“…The number of medications and the complexity of the regimen may also affect adherence to treatment 11,20,33 . For example, fixeddose combinations are associated with greater persistence and adherence than two-pill combinations 34 .…”