Open AccessAdherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add‐ons to metformin: A retrospective cohort database study
Author(s) -
Bloomgarden Zachary T.,
Tunceli Kaan,
Liu Jinan,
Brodovicz Kimberly G.,
Mavros Panagiotis,
Engel Samuel S.,
Radican Larry,
Chen Yong,
Rajpathak Swapnil,
Qiu Ying,
Brudi Philippe,
Fonseca Vivian
Publication year - 2017
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12461
Subject(s) - medicine , sitagliptin , discontinuation , propensity score matching , metformin , retrospective cohort study , logistic regression , dipeptidyl peptidase 4 inhibitor , concomitant , sulfonylurea , diabetes mellitus , cohort , type 2 diabetes , endocrinology , insulin
Background Data are limited regarding adherence to dipeptidyl peptidase‐4 inhibitors. Methods The present retrospective cohort study of a claims database involved adults with type 2 diabetes mellitus, continuous enrollment for 12 months before the first prescription of add‐on sitagliptin (SITA) or a sulfonylurea (SU) to metformin (MET) monotherapy (index date), and ≥45 days of MET coverage ≤90 days before the index date. The SITA and SU users were matched on duration of follow‐up and propensity score (PS). Logistic regression analysis incorporated age, gender, comorbidities, and concomitant medications as independent variables. Results Approximately 99 % of SITA patients were PS matched, resulting in 14 807 well‐balanced PS‐matched SITA/SU pairs. Mean proportion of days covered (PDC) was significantly higher for SITA (vs SU) + MET after 1 year ( P < 0.001). Adherence (PDC ≥80 %) to SITA (vs SU) + MET was 59.1 % (vs 55.9 %; P < 0.001) at 1 year and 52.6 % (vs 49.9 %; P = 0.007) at 2 years. Using logistic regression models including out‐of‐pocket expense (OPE) as a covariate, we found improved mean PDC and adherence for SITA (vs SU) + MET. Numbers of patients who continued to use SITA (vs SU) + MET were significantly higher after Years 1, 2, and 3 (all P < 0.05). Conclusions Users of SITA + MET had significantly higher mean PDC, adherence, and persistence than those on SU + MET. These trends were robust to model alterations and were more marked when accommodating OPEs.