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Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes

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Abstract

Aims

Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors.

Methods

MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed.

Results

Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3–64.4) at one year and 44.2% (95% CI 36.4–52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5–79.5) at six months to 52.8% (95% CI 51.6–59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1–3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest.

Conclusions

Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.

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Funding

No funding or sponsorship was received for this study or publication of this article.

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Authors and Affiliations

Authors

Contributions

RO conceived the study. OO and RO were responsible for articles’ screening and data collection. DG, AM, and GJ supplied additional data. RO performed the statistical analysis and drafted manuscript. OO, MM, KLC, DG, AM, BSW, GJ, MJK, BA, ZA, MLDB, and DL critically reviewed the manuscript for intellectual content.

Corresponding author

Correspondence to Richard Ofori-Asenso.

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Conflict of interest

DL reports past participation in advisory boards and/or receiving honoraria from Abbvie, Astellas, AstraZeneca, Bristol-Myers Squibb, Novartis, Pfizer, Sanofi, and Shire for work unrelated to this study. RO and MLDB are employees of the Copenhagen Centre for Regulatory Sciences (CORS). CORS is a cross-faculty university anchored institution involving various public (Danish Medicines Agency, Copenhagen University) and private stakeholders (Novo Nordisk, Lundbeck, Ferring pharmaceuticals, LEO pharma) as well as patient organizations (Rare Diseases Denmark). The center is purely devoted to the scientific aspects of the regulatory field and with a patient-oriented focus, and the research is not company-specific product or directly company related and has received funding from Novo Nordisk, Ferring Pharmaceuticals, LEO pharma and Lundbeck for projects not related to this study. AM reports research funding from Eli Lilly, AstraZeneca, Boehringer Ingelheim, and Pfizer for work unrelated to this study. All others declare no relevant conflicts of interest.

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Ogundipe, O., Mazidi, M., Chin, K.L. et al. Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes. Acta Diabetol 58, 39–46 (2021). https://doi.org/10.1007/s00592-020-01590-w

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