A retrospective study of persistence, adherence, and health economic outcomes of fixed-dose combination vs loose-dose combination of oral anti-diabetes drugs

Lokhandwala, Tasneem; Smith, Nancy; Sternhufvud, Catarina; Sörstadius, Elisabeth; Lee, Won Chan; Mukherjee, Jayanti

doi:10.3111/13696998.2015.1109518

Cited by 37 publications

(49 citation statements)

References 17 publications

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“…In a retrospective study, patients with type 2 diabetes treated with FDC had a low rate of non-persistence [7]. Drug adherence was reported to increase when patients were switched from LDC therapy with pioglitazone and metformin to analogous FDC therapy [8]. It was reported that treatment with FDC was associated with lower costs and increased possibility of achieving the target HbA1c in a retrospective study [12].…”

Section: Discussionmentioning

confidence: 99%

“…Many FDC regimens for hypertension are available in Japan, but only five for diabetes. In retrospective studies, switching from loose dose combination (LDC) therapy to FDC therapy improved adherence [7, 8]. In another retrospective study, the most recent HbA1c level of patients who took an FDC of DPP-4 inhibitor and metformin was lower than that of patients who took an LDC of DPP-4 inhibitor and metformin free form [9].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Switching From an Anti-Diabetic Loose Dose Combination to a Fixed Dose Combination Regimen at Equivalent Dosage for 6 Months on Glycemic Control in Japanese Patients With Type 2 Diabetes: A Pilot Study

Aoki

Nagakura²,

Taguri

et al. 2017

J Clin Med Res

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BackgroundPatients with type 2 diabetes mellitus often take multiple anti-diabetic drugs for a long period. Fixed dose combination (FDC) therapy is expected to improve drug adherence for patients with diabetes. The effect of switching from a loose dose combination (LDC) regimen to an FDC regimen at equivalent dosage on glycemic control has not been evaluated fully. Therefore, we investigated the effect of switching from LDC to FDC at equivalent dosage for 6 months on glycemic control in Japanese patients with type 2 diabetes.MethodsThirty-eight Japanese patients with type 2 diabetes who were taking anti-diabetic drugs including pioglitazone + metformin, pioglitazone + alogliptin, or pioglitazone + glimepiride were enrolled. These drugs were switched to an FDC of Metact®, Liobel® or Sonias®, respectively, at equivalent dosage. Other anti-diabetic drugs and units of insulin were not changed during the study if possible. HbA1c and body weight were measured 0, 2, 4 and 6 months after switching from an LDC to FDC. We also conducted a questionnaire survey 2 months after the start of the FDC regimen.ResultsHbA1c levels at 2, 4, and 6 months were not significantly changed compared with prior to switching from an LDC to FDC regimen. Moreover, 74.2% of patients considered decreasing the number of drugs to be “very good” or “good”.ConclusionHbA1c levels did not differ between patients receiving LDC and FDC therapy at equivalent dosage in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Switching From an Anti-Diabetic Loose Dose Combination to a Fixed Dose Combination Regimen at Equivalent Dosage for 6 Months on Glycemic Control in Japanese Patients With Type 2 Diabetes: A Pilot Study

Aoki

Nagakura²,

Taguri

et al. 2017

J Clin Med Res

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“…However, data directly addressing the effects of antihyperglycemic SPCs with respect to health care costs are quite limited [82]. Some data suggest reduced health care utilization and costs with an SPC versus loose-pill regimens [11]—a paradox as many formularies penalize SPCs with higher prices. Prescribing an SPC limits dose flexibility, and thus many physicians prefer using them as a maintenance option rather than an initial therapy.…”

Section: Spc Therapymentioning

confidence: 99%

“…For example, insulins and sulfonylureas (SUs) are associated with weight gain and hypoglycemia [1], the latter being of particular concern in the elderly [10]. The management of T2DM may be facilitated with single-pill combinations (SPC) by enabling patients to take fewer pills per day, which may lead to improved patient adherence [11]. Many combinations include metformin and can be used early in the disease.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

Zonszein

Groop

2016

Diabetes Ther

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IntroductionThe duration of uncontrolled type 2 diabetes mellitus (T2DM) can adversely impact small and large vessels, eventually leading to microvascular and macrovascular complications. Failure of therapeutic lifestyle changes, monotherapy, and clinical inertia contribute to persistent hyperglycemia and disease progression. The aim was to review the complex pathophysiology of type 2 diabetes and how different oral agents can be used effectively as first-line therapy in combination with metformin, as well as in patients not achieving glycemic goals with metformin therapy.MethodsFor this review, a non-systematic literature search of PubMed, NCBI, and Google Scholar was conducted.ResultsNew oral agents have made it possible to improve glycemic control to near-normal levels with a low risk of hypoglycemia and without weight gain, and sometimes with weight loss. Early combination therapy is effective and has been shown to have a favorable legacy effect. A number of agents are available in a single-pill combination (SPC) that provides fewer pills and better adherence. Compared with adding a sulfonylurea, still the most common oral combination used, empagliflozin has been shown to decrease cardiovascular (CV) events in a dedicated CV outcome study, and pioglitazone has been effective in reducing the risk of secondary CV endpoints, whereas sulfonylureas have been associated with an increased risk of CV disease. In those failing metformin, triple oral therapy by adding a non-metformin SPC such as empagliflozin/linagliptin or pioglitazone/alogliptin is a good option for reducing glycated hemoglobin (HbA1c) without significant hypoglycemia.ConclusionClinicians have a comprehensive armamentarium of medications to treat patients with T2DM. Clinical evidence has shown that dual or triple oral combination therapy is effective for glycemic control, and early treatment is effective in getting patients to goal more quickly. Use of SPCs is an option for double or triple oral combination therapy and may result in better adherence.

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“…Importantly, adherence to fixed-dose combinations of oral antidiabetic treatments is better than adherence to free drug combinations [7]. Not surprisingly, non-adherence to treatment is consistently associated with poorer glycemic control; HbA 1c levels are higher by 0.4-0.7% in nonadherent compared with adherent patients [4].…”

mentioning

confidence: 99%

Adherence to antihyperglycemic treatment: a work in progress

Τζιόμαλος

2016

Expert Opinion on Pharmacotherapy

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A retrospective study of persistence, adherence, and health economic outcomes of fixed-dose combination vs loose-dose combination of oral anti-diabetes drugs

Abstract: Management of T2DM using FDC therapies provides a compliance benefit relative to LDC therapies that may translate to reductions in healthcare utilization and costs.

Cited by 37 publications

References 17 publications

Effect of Switching From an Anti-Diabetic Loose Dose Combination to a Fixed Dose Combination Regimen at Equivalent Dosage for 6 Months on Glycemic Control in Japanese Patients With Type 2 Diabetes: A Pilot Study

Effect of Switching From an Anti-Diabetic Loose Dose Combination to a Fixed Dose Combination Regimen at Equivalent Dosage for 6 Months on Glycemic Control in Japanese Patients With Type 2 Diabetes: A Pilot Study

Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease

Adherence to antihyperglycemic treatment: a work in progress

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