Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes

Abstract

Aims Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors. Methods MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed. Results Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3-64.4) at one year and 44.2% (95% CI 36.4-52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5-79.5) at six months to 52.8% (95% CI 51.6-59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1-3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest. Conclusions Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.

Drug utilisation pattern over 3 years in the real‐world treatment of type II diabetes

“…In this regard, the present study offers data over 3 years and, a more reliable indication, especially in terms of persistence. Most studies stop at 12 months of analysis 32 …”

Adherence and persistence rates of major antidiabetic medications: a review

“…The speculation that regimen complexity or the severity of diabetes may not necessarily lower adherence to DPP4 inhibitors [ 23 ] was supported by several studies [ 57 – 59 ]. Common reasons for discontinuing DPP4 inhibitors were inadequate glycemic control and intolerance, as with other antidiabetic medications [ 61 ].…”

2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care

“…The discontinuation rate in RCTs was 31.8% (17.0%; 46.7%) in a total of 7 studies evaluated and the mean persistence rate was 56.2% (46.1%; 66.3%) in a total of 6 studies evaluated [50]. In another systematic review and meta-analysis that included 34 cohort studies involving almost 600,000 patients with T2D receiving oral an antidiabetic drug, 56.9% (49.3%; 64.4%) of patients with T2D were adherent at one year (proportion of days covered or medication possession ratio ≥0.80) and 44.2% (36.4%; 52.1%) at two years [51]. A third systematic review and meta-analysis comprising 48 studies showed that adherence was better for sulphonylureas (SUs) and thiazolidinediones when compared with metformin.…”