Retrospective Analysis of Long-Term Adherence to and Persistence with DPP-4 Inhibitors in US Adults with Type 2 Diabetes Mellitus

Farr, Amanda M.; Sheehan, John J.; Curkendall, Suellen M.; Smith, David M.; Johnston, Stephen S.; Kalsekar, Iftekhar

doi:10.1007/s12325-014-0171-3

Cited by 70 publications

(77 citation statements)

References 24 publications

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“…These data are consistent with previous realworld studies, which have demonstrated that poor medication adherence to both oral and injectable antidiabetes agents is very common (35)(36)(37). For example, a retrospective analysis of the MarketScan Commercial and Medicare Supplemental databases targeting adults initiating oral agents in the DPP-4 inhibitor (n = 61,399), sulfonylurea (n = 134,961), and thiazolidinedione (n = 42,012) classes found that adherence rates, as measured by PDC $80% at the 1-year mark after the initial prescription, were below 50% for all three classes, at 47.3%, 41.2%, and 36.7%, respectively (36).…”

Section: A Closer Look At the Problemsupporting

confidence: 92%

“…For example, a retrospective analysis of the MarketScan Commercial and Medicare Supplemental databases targeting adults initiating oral agents in the DPP-4 inhibitor (n = 61,399), sulfonylurea (n = 134,961), and thiazolidinedione (n = 42,012) classes found that adherence rates, as measured by PDC $80% at the 1-year mark after the initial prescription, were below 50% for all three classes, at 47.3%, 41.2%, and 36.7%, respectively (36). Rates dropped even lower at the 2-year follow-up (36) (Fig.…”

Section: A Closer Look At the Problemmentioning

confidence: 99%

“…A: A real-world study of 238,372 patients with type 2 diabetes taking oral diabetes medications found that adherence rates, defined as a PDC $80%, were consistently less than 50% across three oral drug classes at the 1-year time point and dropped to approximately 40% at the 2-year follow-up (35). Using administrative claims from a U.S. health plan affiliated with Optum, a retrospective study of 1,321 patients with type 2 diabetes treated with liraglutide once daily found that adherence rates were 34% for injectable GLP-1 RAs (36). B: A retrospective cohort study, conducted using data extracted from Truven Health Analytics MarketScan commercial health insurance database, found that less than 25% of patients on DPP-4 inhibitors were persistent with therapy at 12 months; the rate for GLP-1 RAs even worse, with only approximately 15% of the more than 134,000 patients who initiated GLP-1 RAs considered persistent with therapy (38).…”

Section: The Ultimate Price Of Poor Adherence and Persistencementioning

confidence: 99%

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Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

2017

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Despite U.S. Food and Drug Administration (FDA) approval of over 40 new treatment options for type 2 diabetes since 2005, the latest data from the National Health and Nutrition Examination Survey show that the proportion of patients achieving glycated hemoglobin (HbA 1c ) <7.0% (<53 mmol/mol) remains around 50%, with a negligible decline between the periods 2003-2006 and 2011-2014. The Healthcare Effectiveness Data and Information Set reports even more alarming rates, with only about 40% and 30% of patients achieving HbA 1c <7.0% (<53 mmol/mol) in the commercially insured (HMO) and Medicaid populations, respectively, again with virtually no change over the past decade. A recent retrospective cohort study using a large U.S. claims database explored why clinical outcomes are not keeping pace with the availability of new treatment options. The study found that HbA 1c reductions fell far short of those reported in randomized clinical trials (RCTs), with poor medication adherence emerging as the key driver behind the disconnect. In this Perspective, we examine the implications of these findings in conjunction with other data to highlight the discrepancy between RCT findings and the real world, all pointing toward the underrealized promise of FDA-approved therapies and the critical importance of medication adherence. While poor medication adherence is not a new issue, it has yet to be effectively addressed in clinical practicedoften, we suspect, because it goes unrecognized. To support the busy health care professional, innovative approaches are sorely needed. ACHIEVEMENT OF HbA 1c GOALS IN THE REAL WORLDLarge randomized controlled trials (RCTs) have clearly demonstrated that achieving and sustaining optimal glycemic control prevents or delays the development of microvascular and macrovascular disease (1-3). Although the risk of developing diabetesrelated complications rises steadily when glycated hemoglobin (HbA 1c ) values are in excess of 6.5% (48 mmol/mol) (4,5), an HbA 1c of ,7% (,53 mmol/mol) is generally considered a target goal for diabetes management (6). In truth, it is now widely recognized that individualizing the HbA 1c goal for each patient is critically important, especially when the presence of comorbidities necessitates less stringent targets (6). However, most government and private insurer reports continue to use 7% as a point of reference; therefore, we focus herein on this marker of glycemic control.Despite our growing understanding of diabetes and the availability of new medications and technologies, a substantial number of individuals are not at their glycemic goal. Of note, recent data indicate that 85.6% of adults with diagnosed diabetes are treated with diabetes medication (7). Results from the National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of American adults with diabetes are achieving HbA 1c ,7.0% (,53 mmol/mol) (8), and it is estimated that only 64% are reaching individualized glycemic goals (9). These findings are noteworthy

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Section: A Closer Look At the Problemsupporting

confidence: 92%

Section: A Closer Look At the Problemmentioning

confidence: 99%

Section: The Ultimate Price Of Poor Adherence and Persistencementioning

confidence: 99%

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Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

2017

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“…This may be because monotherapy users had less severe diabetes and better glycaemic control; taking fewer drugs may also decrease the risks of adverse drug effects and drug interactions. We also observed inferior adherence to sulfonylureas and TZD, probably due to intolerance to certain adverse effects such as weight gain . Furthermore, our findings suggested that the use of mail order pharmacies tended to increase medication adherence, which corroborated the conclusions of many previous studies of various populations .…”

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confidence: 90%

Oral antidiabetic drug use and associated health outcomes in cancer patients

et al. 2016

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“…Furthermore, patient adherence and persistence have been shown to be greater with DPP-4 inhibitors as initial pharmacotherapy compared with other classes of antidiabetes medications such as sulfonylureas and thiazolidinediones [19]. Clinical practice guidelines recommend DPP-4 inhibitors as an option for first-line therapy in individuals who are intolerant to metformin or in whom metformin is contraindicated [6,7].…”

Section: Discussionmentioning

confidence: 99%

Saxagliptin Responder Analysis: A Pooled Analysis of 5 Clinical Trials

Sjöstrand¹,

Leibowitz²

2016

J Diabetes Metab

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Objective: To assess the treatment response of patients with T2DM to saxagliptin at 24 weeks based on their initial response to saxagliptin at 12 weeks.Methods: Data were pooled from five 24-week, randomized, placebo-controlled trials of saxagliptin. Patients (N=1994) were categorized by change in glycated hemoglobin (HbA1c) after 12 weeks of saxagliptin treatment as responders (HbA1c decrease ≥ 0.5%; 61% of saxagliptin-treated patients), intermediate responders (HbA1c decrease ≥ 0.2% and <0.5%; 14% of patients), and nonresponders (HbA1c decrease <0.2%; 25% of patients). [-4.8%, 5.6%]). Baseline characteristics that were associated with glycemic response to saxagliptin included higher baseline HbA1c (P<0.0001), higher HOMA-2%β (P<0.0001), lower fasting insulin (P=0.0006), shorter T2DM duration (P=0.033), and male sex (P=0.031). Results Conclusion:Responders, who comprised 61% of saxagliptin-treated patients analyzed, derived significant benefit from saxagliptin, with a ~1% decline in HbA1c and increased β-cell function at 24 weeks compared with nonresponders.

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Retrospective Analysis of Long-Term Adherence to and Persistence with DPP-4 Inhibitors in US Adults with Type 2 Diabetes Mellitus

Cited by 70 publications

References 24 publications

Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control

Oral antidiabetic drug use and associated health outcomes in cancer patients

Saxagliptin Responder Analysis: A Pooled Analysis of 5 Clinical Trials

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