Patterns and trends of utilization of incretin-based medicines between 2008 and 2014 in three Italian geographic areas

Abstract

BackgroundThe incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice.MethodsA multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing.ResultsThe overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2‰ for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6‰; DPP4i = 2.5‰) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin.ConclusionsDuring the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy.Electronic supplementary materialThe online version of this article (10.1186/s12902-019-0334-y) contains supplementary material, which is available to authorized users.

Changing Patterns of Antihyperglycaemic Treatment among Patients with Type 2 Diabetes in Hungary between 2015 and 2020—Nationwide Data from a Register-Based Analysis

“…Taken together, our results are consistent with recent similar registry-based surveys from different countries in Europe (Sweden, Greece, Italy, Denmark, Romania) [ 47 , 48 , 49 , 50 , 51 , 52 ].…”

Utilization patterns, cardiovascular risk, and concomitant serotoninergic medications among triptan users between 2008 and 2018: A gender analysis in one Italian region, Tuscany

“…The population‐based, Administrative Healthcare Database of the Regional Health Agency (ARS) of Tuscany was used. It contains patient‐level information collected in different administrative data banks that record healthcare services delivered to participants registered with a general practitioner in the Tuscany region 23,24 . A unique regional pseudo anonymized personal identifier (ID) is used for the record‐linkage of the different available data banks.…”

“…It contains patient-level information collected in different administrative data banks that record healthcare services delivered to participants registered with a general practitioner in the Tuscany region. 23,24 A unique regional pseudo anonymized personal identifier (ID) is used for the record-linkage of the different available data banks. Only healthcare services reimbursed by the NHS are recorded in the ARS database.…”

“…43 Indeed, the administrative database of Tuscany has been extensively used for pharmacoepidemiologic research. 24,44 Nevertheless, there are also important study limitations that stem from the data source characteristics. Notably, exposure to triptans was assessed assuming that the amount of drug dispensed relates to the actual amount of drug taken by patients.…”

Time to Treatment Intensification in Patients Receiving DPP4 Inhibitors Versus Sulfonylureas as the First Add-On to Metformin Monotherapy: A Retrospective Cohort Study

“…Currently available incretin-based medicines are distinguished in two main groups: GLP-1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i). Indeed, DPP4i are the most widely used incretin-based therapies, given their higher convenience of use compared to GLP1a (i.e., oral vs. subcutaneous administration) ( Schneeweiss et al, 2011 ; Italian Standards of Medical Care of Diabetes, 2014 ; Roberto et al, 2019 ).…”