Adherence and Persistence with DPP-4 Inhibitors Versus Pioglitazone in Type 2 Diabetes Patients with Chronic Kidney Disease: A Retrospective Claims Database Analysis

Abstract

Diabetes is a highly prevalent chronic metabolic disease that affects 9.4% of the U.S. population. 1 Chronic kidney disease (CKD), a common comorbidity and complication of the disease, is estimated to affect approximately 35%-40% of patients with type 2 diabetes mellitus (T2DM). 2 The risks of cardiovascular complications, hospitalization, and death increase with decreasing kidney function. 3 In addition, patients with diabetes and CKD have substantially higher medical care costs compared with those patients with diabetes alone. 4 Achieving glycemic control using pharmacotherapy is essential for the avoidance of disease progression and diabetesrelated complications. Glycemic control has also been associated with better clinical outcomes, including reduced risks of cardiovascular events and progression of CKD and end-stage renal disease (ESRD) among patients with CKD. 5 Numerous studies have demonstrated the role of adherence in attaining glycemic targets and potential savings for patients with T2DM. 6 For every 10% increase in adherence, hemoglobin A1c (HbA1c) decreases by approximately 0.1%. 6 Nonadherence has been associated with 7% higher risk of hospitalization, 3.6% higher mean number of visits, and 10% higher risk of mortality. 6,7 Studies have suggested reductions in total medical cost,

Adherence and persistence rates of major antidiabetic medications: a review

“…This safety profile leads to good adherence and persistence in DPP4 inhibitor users. The mean PDC at one year of DPP4 inhibitors ranged from 0.67 to 0.77 [ 56 , 57 ]. The percentage of patients who remained persistent to DPP4 inhibitors at one year was between 56.7 and 78.8% [ 27 , 57 ].…”

“…The mean PDC at one year of DPP4 inhibitors ranged from 0.67 to 0.77 [ 56 , 57 ]. The percentage of patients who remained persistent to DPP4 inhibitors at one year was between 56.7 and 78.8% [ 27 , 57 ]. The median persistence of DPP4 inhibitors was approximately seventeen months [ 2 , 58 ].…”

“…However, DPP4 inhibitors are well adhered and persisted in T2DM patients with impaired kidney functions at all renal impairment stages [ 58 ]. Similarly, the adherence of DPP4 inhibitors in patients with chronic kidney disease (CKD) was significantly higher (OR [95% CI] of adherence for DPP4 inhibitors: 1.41 [1.25–1.59], p < 0.01) than pioglitazone, a well-established second-line therapy for T2DM patients with CKD [ 57 ].…”

“…The speculation that regimen complexity or the severity of diabetes may not necessarily lower adherence to DPP4 inhibitors [ 23 ] was supported by several studies [ 57 – 59 ]. Common reasons for discontinuing DPP4 inhibitors were inadequate glycemic control and intolerance, as with other antidiabetic medications [ 61 ].…”

“…TZDs reduce plasma glucose by directly activating PPAR-γ and improving insulin sensitivity [ 78 , 79 ]. Furthermore, TZDs, along with DPP4 inhibitors, are the major treatment option for T2DM patients with impaired renal functions [ 57 ]. Despite their therapeutic benefits, few studies published since 2017 analyzed the adherence and persistence of TZDs due partly to the diminished market share (in case of rosiglitazone) or withdrawal from the market (in case of troglitazone) [ 20 , 80 – 82 ].…”