Adherence, persistence, and treatment discontinuation with sitagliptin compared with sulfonylureas as add-ons to metformin: A retrospective cohort database study

Zachary T. Bloomgarden, Kaan Tunceli, Jinan Liu, Kimberly G. Brodovicz, Panagiotis Mavros, Samuel S. Engel, Larry Radican, Yong Chen, Swapnil Rajpathak, Ying Qiu, Philippe Brudi, Vivian Fonseca

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)677-688
Number of pages12
JournalJournal of Diabetes
Volume9
Issue number7
DOIs
StatePublished - Jul 2017

Keywords

  • adherence
  • dipeptidyl peptidase-4 inhibitors
  • metformin
  • sitagliptin
  • sulfonylureas

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