Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study

Abstract

ObjectiveTo determine real-world trends in antidiabetic drug use, and persistence and adherence, in Japanese patients with type 2 diabetes mellitus (T2DM).DesignRetrospective evaluation of administrative claims data (2011–2015) using the Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases.SettingAnalysis of two administrative claims databases for Japanese patients with T2DM.ParticipantsAdults (aged ≥18 years) with an International Classification of Diseases, 10th Revision code of T2DM and at least one antidiabetic drug prescription.Main outcome measuresTreatment patterns in untreated (UT) or previously treated (PT) patients receiving antidiabetic therapy; persistence with treatment at 12 months; adherence to treatment at 12 months.Results40 908 and 90 421 patients were included from the JMDC and MDV databases, respectively. The most frequently prescribed therapy at the index (first prescription) date was dipeptidyl peptidase-4 inhibitor (DPP-4i) in UT patients (JMDC: 44.0%, MDV: 54.8%) and combination therapy in PT patients (74.6%, 81.1%). Most common combinations were DPP-4i plus: biguanide (BG; 11.4%, 10.9%), sulfonylurea (SU; 8.4%, 11.0%) or BG+SU (7.8%, 9.1%). In UT or PT patients from either database whose index prescription was for any antidiabetic drug class(es) other than DPP-4i, the most frequent add-on or switch was to DPP-4i. 12-month persistence with index monotherapy was highest with DPP-4i and BG. Adherence was high (≥80%) for all monotherapy schedules, except insulin and glucagon-like peptide-1 agonist, and for the five most frequent two-drug and three-drug combinations. Persistence was greater in elderly UT patients and in those receiving ≤5 medications, but comparatively worse in UT patients with ≥3 index antidiabetic drug classes.ConclusionsThe findings indicate that DPP-4i is the most commonly used antidiabetic drug class in Japanese patients with T2DM, and persistence and adherence to this antidiabetic drug class are high.

Long-Term Safety and Efficacy of Sitagliptin for Type 2 Diabetes Mellitus in Japan: Results of a Multicentre, Open-Label, Observational Post-Marketing Surveillance Study

“…DPP4 inhibitors have demonstrated sufficient efficacy in lowering blood glucose with a lower risk of hypoglycaemia compared with other insulin secretagogues such as sulfonylureas [15]. Owing to their well-balanced benefit to risk characteristics, DPP4 inhibitors are currently the most commonly prescribed oral hypoglycaemic agents in Japan [16].…”

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

“…Although patients with a PDC 0.8 have been considered to have good adherence to treatment 27,29 , this cut-off should be interpreted with caution. Adherence rate was defined as PDC divided by the number of days.…”

“…A recently published real-world study, based on Japanese health insurance claims data, found that the use of, and persistence and adherence to, DPP-4i-containing regimens was high among previously treated and previously untreated Japanese patients with T2DM 27 . The availability of new treatment regimens in Japan, particularly once-weekly dosing, coupled with universal health insurance coverage and unrestricted access to almost any healthcare provider means that patients are able to select physicians or medical facilities of their choice.…”

Identification of subgroups of patients with type 2 diabetes with differences in renal function preservation, comparing patients receiving sodium‐glucose co‐transporter‐2 inhibitors with those receiving dipeptidyl peptidase‐4 inhibitors, using a supervised machine‐learning algorithm (PROFILE study): A retrospective analysis of a Japanese commercial medical database

“…Indeed, a recent analysis of two Japanese clinical databases (Japan Medical Data Centre [JMDC] database and Medical Data Vision [MDV] database) showed that DPP-4 inhibitors were frequently prescribed in previously untreated patients (JMDC: 44.0%; MDV: 54.8%) and as part of combination therapy in previously treated patients (JMDC: 74.6%; MDV: 81.1%). 23 Adherence and persistence to DPP-4 inhibitors were also found to be high in both databases. Although prior studies have indirectly compared the effects of SGLT2 inhibitors and DPP-4 inhibitors on glycaemic control, body weight and cardiovascular events, 24,25 none, to our knowledge, has compared their effects on renal function.…”

“…For this purpose, we analysed a large Japanese medical database using patients treated with dipeptidyl peptidase‐4 (DPP‐4) inhibitors as a reference group because these drugs have been available in Japan for ~8 years, have a complementary mechanism of action to SGLT2 inhibitors and, in our experience, are widely prescribed to patients with type 2 diabetes in Japan. Indeed, a recent analysis of two Japanese clinical databases (Japan Medical Data Centre [JMDC] database and Medical Data Vision [MDV] database) showed that DPP‐4 inhibitors were frequently prescribed in previously untreated patients (JMDC: 44.0%; MDV: 54.8%) and as part of combination therapy in previously treated patients (JMDC: 74.6%; MDV: 81.1%) . Adherence and persistence to DPP‐4 inhibitors were also found to be high in both databases.…”