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Jermendy G, Kiss Z, Rokszin G, Abonyi-Tóth Z, Wittmann I, Kempler P. Persistence to Treatment with Novel Antidiabetic Drugs (Dipeptidyl Peptidase-4 Inhibitors, Sodium-Glucose Co-Transporter-2 Inhibitors, and Glucagon-Like Peptide-1 Receptor Agonists) in People with Type 2 Diabetes: A Nationwide Cohort Study. Diabetes Ther 2018; 9:2133-2141. [PMID: 30120754 PMCID: PMC6167279 DOI: 10.1007/s13300-018-0483-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Adequate persistence to antidiabetic treatment is highly important to achieve proper glycemic control. In this study we evaluate the persistence to treatment with dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists in a nationwide cohort of patients with type 2 diabetes. METHODS Using a central database in Hungary, we analyzed the persistence to the treatment with dipeptidyl peptidase-4 inhibitors (n = 59,900), sodium-glucose co-transporter-2 inhibitors (n = 26,052), and glucagon-like peptide-1 receptor agonists (n = 17,332) at treatment intensification between 2014 and 2016. We also compared the persistence of dipeptidyl peptidase-4 inhibitors (n = 9163) and sodium-glucose co-transporter-2 inhibitors (n = 1257) in initial therapy to that of metformin (n = 79,305) or sulfonylureas (n = 29,057). The rates of persistence to treatment and risk of non-persistence are reported. RESULTS The persistence rates of dipeptidyl peptidase-4 inhibitors, sodium-glucose co-transporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists at treatment intensification were 69.6%, 67.8%, and 66.3% at year 1 which decreased to 57.3%, 56.8%, and 52.1% by year 2, respectively. The risk of non-persistence was higher by 6.6% (95% CI 3.6-9.6) for sodium-glucose co-transporter-2 inhibitors and by 8.3% (95% CI 5.0-11.5) for glucagon-like peptide-1 receptor agonists as compared to dipeptidyl peptidase-4 inhibitors. Novel oral antidiabetic drugs in fixed versus free add-on combinations with metformin had higher persistence. The persistence to treatment with novel oral antidiabetic drugs in initial therapy was better (dipeptidyl peptidase-4 inhibitors, 59.6% and 47.6%; sodium-glucose co-transporter-2 inhibitors, 61.9% and 47.0%) than that of initial monotherapy with metformin (47.0% and 39.1%) or sulfonylureas (52.4% and 41.8%) at years 1 and 2, respectively. CONCLUSION Analysis of persistence of treatment with novel glucose-lowering medications revealed differences between drug classes, favoring dipeptidyl peptidase-4 inhibitors vs. sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Persistence data of novel antihyperglycemic agents may be useful for guiding the decision at initiation of antidiabetic treatment. FUNDING Hungarian Diabetes Association. Plain language summary available for this article.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, 1106, Budapest, Hungary.
| | - Zoltán Kiss
- Faculty of Medicine, 2nd Department of Medicine and Nephrological Center, University of Pécs, Pacsirta út 1, 7624, Pécs, Hungary
| | - György Rokszin
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary
| | | | - István Wittmann
- Faculty of Medicine, 2nd Department of Medicine and Nephrological Center, University of Pécs, Pacsirta út 1, 7624, Pécs, Hungary
| | - Péter Kempler
- Faculty of Medicine, 1st Department of Medicine, Semmelweis University, Korányi Sándor út 2, 1083, Budapest, Hungary
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Alfian SD, Worawutputtapong P, Schuiling-Veninga CCM, van der Schans J, Bos JHJ, Hak E, Denig P. Pharmacy-based predictors of non-persistence with and non-adherence to statin treatment among patients on oral diabetes medication in the Netherlands. Curr Med Res Opin 2018; 34:1013-1019. [PMID: 29292657 DOI: 10.1080/03007995.2017.1417242] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To evaluate statin non-persistence and non-adherence as discrete processes in diabetes patients, and identify pharmacy-based predictors of these processes in the first year after statin initiation. METHODS We conducted a retrospective cohort study of statin initiators using a pharmacy database. Persistence and adherence were measured in the first, second and third year. Non-persistence was defined as a gap >180 days. Non-adherence was calculated in persistent patients and defined as a medication possession ratio <80%. Cox regression hazard ratios (HRs) and logistic regression odds ratios (ORs) were assessed for sociodemographic and medication-related factors as possible predictors. RESULTS Of 12,741 initiators, 20.0% were non-persistent in the first year, while 9.0% and 7.5% were non-persistent in the second and third years. Non-adherence in persistent patients increased from 13.4% in the first to 15.6% and 18.1% in the second and third years. Predictors of non-persistence were female gender (HR: 1.10; 95% CI: 1.01-1.19), older age (HR: 1.52; 95% CI: 1.31-1.75), primary prevention (HR: 1.10; 95% CI: 1.00-1.20), initiating on low dose (HR: 1.44; 95% CI: 1.07-1.94) or standard dose (HR: 1.56; 95% CI: 1.16-2.10), and no cardiovascular co-medication (HR: 1.19; 95% CI: 1.07-1.33), while patients with four or more other medications were more likely to be persistent. Age <50 years (OR: 1.47; 95% CI: 1.22-1.77), low socioeconomic status (OR: 1.27; 95% CI: 1.12-1.45) and primary prevention (OR: 1.21; 95% CI: 1.07-1.38) were predictors of non-adherence, while females were more likely to be adherent (OR: 0.87; 95% CI: 0.77-0.98). CONCLUSION Non-persistence was the foremost problem in the first year after statin initiation, while non-adherence in persistent patients increased in the second and third years. Pharmacy-based predictors of statin non-persistence were different from predictors of non-adherence among persistent patients.
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Affiliation(s)
- Sofa D Alfian
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
- b Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy , Universitas Padjadjaran , Indonesia
| | - Pawida Worawutputtapong
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
| | - Catharina C M Schuiling-Veninga
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
| | - Jurjen van der Schans
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
| | - Jens H J Bos
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
| | - Eelko Hak
- a Unit of PharmacoTherapy, -Epidemiology, & -Economics , Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands
| | - Petra Denig
- c Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Using Individual Experiences With Experimental Medications to Predict Medication-Taking Behavior Postauthorization: A DIA Study Endpoints Workstream. Ther Innov Regul Sci 2017; 51:404-415. [DOI: 10.1177/2168479017701979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gupta S, Gersing KR, Erkanli A, Burt T. Antidepressant Regulatory Warnings, Prescription Patterns, Suicidality and Other Aggressive Behaviors in Major Depressive Disorder and Anxiety Disorders. Psychiatr Q 2016; 87:329-42. [PMID: 26303613 DOI: 10.1007/s11126-015-9389-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2004 the Food and Drug Administration issued a warning on the risk of suicidality in children and adolescents receiving antidepressants. This was followed by reports of changes in antidepressant prescription patterns, suicidality and other aggressive behaviors, but debate is continuing regarding the nature and magnitude of these changes. We examined a large physician database for impact of the warning on antidepressant prescriptions, suicidality and other aggressive behaviors in major depressive disorder (MDD) and anxiety disorders in adult and pediatric patients. We analyzed electronic database covering over 100,000 patients, treated in Pre- (before 2003) and Post- (after 2004) warning periods. We compared strength of the association between the measures and the time period with two tests. Multivariate logistic regression analyses were performed to ascertain the unique effect of each parameter. Of 10,089 MDD (61.0 %) and anxiety disorders (39.0 %) patients, 65.2 % received antidepressant prescription and 16.1 % were pediatric patients. In post-warning period, there was a greater reduction in adult versus pediatric antidepressant prescription rates. Logistic modeling showed greater likelihood of antidepressant prescription in MDD as compared with anxiety disorders in post-warning period. Pediatric patients were more likely than adults to receive fluoxetine during the post-warning period. There was an overall reduction in suicidality and other aggressive behaviors in the post-warning period. Regulatory warnings may have had an impact on antidepressant benefit/risk assessment and consequent utilization, therapeutic effects, and adverse events. Our observations suggest that psychiatrists may heed regulatory warnings, but may also exert professional independence and discrimination in their application.
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Affiliation(s)
- Saurabh Gupta
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Kenneth Ronald Gersing
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alaattin Erkanli
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Tal Burt
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Rathe J, Andersen M, Jarbøl DE, dePont Christensen R, Hallas J, Søndergaard J. Generic switching and non-persistence among medicine users: a combined population-based questionnaire and register study. PLoS One 2015; 10:e0119688. [PMID: 25775472 PMCID: PMC4361595 DOI: 10.1371/journal.pone.0119688] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/15/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Generic substitution means that one medicinal product is replaced by another product containing the same active substance. It is strictly regulated with respect to its bioequivalence, and all products must have undergone appropriate studies. Although generic substitution is widely implemented, it still remains to be answered how generic switch influences persistence to long-term treatment, and if it is modified by patients' concerns about medicine and views on generic medicine. This study focuses on users of antidepressants and antiepileptics, and their experience of generic switching. METHODS The study was an observational cohort study. By use of a prescription database, we identified patients who had redeemed prescriptions on generically substitutable drugs, and a questionnaire was mailed to them. We analyzed predictors of discontinuation in relation to generic switch and patients' attitudes towards generic medicines and concerns about their medicine. RESULTS Patients who experience their first-time switch of a specific drug were at higher risk of non-persistence, Hazard Ratio 2.98, 95% CI (1.81;4.89) versus those who have never switched, and 35.7% became non-persistent during the first year of follow-up. Generic switching did not influence persistence considerably in those having previous experience with generic switching of the specific drug. Stratified analyses on users of antidepressants and antiepileptics underpin the results, showing higher risk of non-persistence for first-time switchers for both drug categories. CONCLUSION In conclusion, patients who are first-time switchers of a specific drug were at higher risk of non-persistence compared to never switchers and those having experienced previous generic switching.
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Affiliation(s)
- Jette Rathe
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - René dePont Christensen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Research Unit of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Aylward BS, Rausch JR, Modi AC. An examination of 1-year adherence and persistence rates to antiepileptic medication in children with newly diagnosed epilepsy. J Pediatr Psychol 2014; 40:66-74. [PMID: 24648257 DOI: 10.1093/jpepsy/jsu010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The primary aim of the current study was to use new methods to examine 1-year quality of medication dosing (adherence) and continuation with medication treatment (persistence) rates to antiepileptic drugs (AEDs) in children with newly diagnosed epilepsy. METHODS Medication-taking behaviors of AEDs were assessed using electronic monitors for 117 children with newly diagnosed epilepsy for the first year after diagnosis. RESULTS Approximately 15% of participants were categorized as nonpersistent (i.e., failed to take medication for >15 consecutive days) 6 months after AED initiation, which increased to 26.6% of participants at 1 year. The majority of medication dosing events took place within a +/-2-hr interval as recommended. The group with lower socioeconomic status demonstrated more nonpersistence over time. CONCLUSION Examining adherence and persistence in medication taking behaviors may yield different types of data for clinical and research purposes.
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Affiliation(s)
- Brandon S Aylward
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Joseph R Rausch
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Avani C Modi
- Department of Pediatrics, Emory University School of Medicine, Department of Neurology and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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A nested case-control study of adjuvant hormonal therapy persistence and compliance, and early breast cancer recurrence in women with stage I-III breast cancer. Br J Cancer 2013; 109:1513-21. [PMID: 24002590 PMCID: PMC3777010 DOI: 10.1038/bjc.2013.518] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 11/26/2022] Open
Abstract
Background: Non-persistence and non-compliance are common in women prescribed hormonal therapy for breast cancer, but little is known about their influence on recurrence. Methods: A nested case–control study of associations between hormonal therapy non-persistence and non-compliance and the risk of early recurrence in women with stage I–III breast cancer was undertaken. Cases, defined as women with a breast cancer recurrence within 4 years of hormonal therapy initiation, were matched to controls (1 : 5) by tumour stage and age. Conditional logistic regression was used to examine associations between early recurrence and hormonal therapy non-persistence and non-compliance. Results: Ninety-four women with breast cancer recurrence were matched to 458 controls. Women who were non-persistent (⩾180 days without hormonal therapy) had a significantly increased adjusted recurrence odds ratio (OR) of 2.88 (95%CI 1.11, 7.46) compared with persistent women. There was no significant association between low compliance (OR 1.30; 95% CI 0.74, 2.30) and breast cancer recurrence. Conclusion: Hormonal therapy non-persistence is associated with a significantly higher risk of early recurrence in women with stage I–III oestrogen receptor (ER)-positive breast cancer. This finding is consistent with results from randomized studies of hormonal therapy treatment duration and suggests that interventions to target modifiable risk factors for non-persistence are required.
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Blackburn DF, Swidrovich J, Lemstra M. Non-adherence in type 2 diabetes: practical considerations for interpreting the literature. Patient Prefer Adherence 2013; 7:183-9. [PMID: 23487395 PMCID: PMC3592508 DOI: 10.2147/ppa.s30613] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The rising prevalence of type 2 diabetes poses a serious threat to human health and the viability of many health care systems around the world. Although several prescription medications can play a vital role in controlling symptoms and preventing complications, non-adherence to these therapies is highly prevalent and has been linked to increases in morbidity, mortality, and health care costs. Although a vast array of significant adherence predictors has been identified, the ability to explain or predict non-adherence with known risk-factors remains poor. Further, the definitions, outcomes, and various measures used in the non-adherence literature can be misleading for the unfamiliar reviewer. In this narrative review, a practical overview of important considerations for interpreting adherence endpoints and measures is discussed. Also, an organizational framework is proposed to consider published adherence interventions. This framework may allow for a unique appreciation into areas of limited knowledge and thus highlights targets for future research.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
- Correspondence: David F Blackburn College of Pharmacy and Nutrition, 110 Science Place, Saskatoon, Saskatchewan, Canada, S7N 5C9 Te l +1 306 966 2081 Fax +1 306 966 6377 Email
| | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
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Jermendy G, Wittmann I, Nagy L, Kiss Z, Rokszin G, Abonyi-Tóth Z, Katona L, Paragh G, Karádi I, Merkely B. Persistence of initial oral antidiabetic treatment in patients with type 2 diabetes mellitus. Med Sci Monit 2012; 18:CR72-77. [PMID: 22293880 PMCID: PMC3560582 DOI: 10.12659/msm.882459] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Adequate persistence of oral antidiabetic treatment is highly important to achieve proper glycemic control in patients with type 2 diabetes. The aim of this study was to evaluate the persistence of initial treatment with metformin and/or sulphonylureas in patients with type 2 diabetes. Material/Methods The study was performed among diabetic patients (n=256,384) who were with newly prescribed oral antidiabetic drugs (metformin and/or sulphonylureas) between 2007 and 2009. For making comparison, patients with newly prescribed statin or clopidogrel therapy (with and without percutaneous coronary intervention) were investigated. The database of the Hungarian National Health Insurance Fund Administration was used. Results The 1-year persistence of initial treatment with metformin, sulphonylureas or metformin/sulphonylurea combination was 47.7%, 45.4% and 55.8%, respectively, which was significantly better than the persistence of statin therapy (26.3%) but worse than that of clopidogrel therapy in patients undergoing coronary intervention (73.2%). Within the sulphonylurea group there was a tendency of better persistence of treatment with the “modified-release” tablets at 12 months compared to the conventional sulphonylureas (47.8 vs. 42.2%). The persistence of therapy using metformin 1000 mg – 60 tablets was significantly better (60.4%) at 12 months than that of other forms of metformin therapy with lower doses and smaller boxes (with fewer tablets) analyzed together (47.7%). Conclusions The persistence of initial treatment with metformin and/or sulphonylureas is far from optimal. Better diabetic care and continuous patient education should be encouraged to achieve higher persistence of oral antidiabetic treatment in patients with type 2 diabetes.
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Affiliation(s)
- György Jermendy
- 3rd Department of Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary.
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