Analysis of the Adherence and Safety of Second Oral Glucose-Lowering Therapy in Routine Practice From the Mediterranean Area: A Retrospective Cohort Study

Vlacho, Bogdan; Mata-Cases, Manel; Mundet-Tudurí, Xavier; Vallès-Callol, Joan-Antoni; Real, Jordi; Farré, Magı́; Cos, Xavier; Khunti, Kamlesh; Mauricio, Dı́dac; Franch-Nadal, Josep

doi:10.3389/fendo.2021.708372

Cited by 8 publications

(23 citation statements)

References 41 publications

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“…35 Despite that canagliflozin, as an SGLT2i, is associated with an increased risk of genital infection, which according to the survey by Savarese et al 30 is ranked as the biggest consideration, and has the most complex administration method of the three SGLT2is, it had the highest reported percentage of adherent patients. However, these adherence data was all reported by Vlacho et al 26 and the sample sizes were relatively small. Thus, more data is needed to investigate the influence of potential adherence barriers on treatment adherence.…”

Section: Discussionmentioning

confidence: 59%

“…The DPP4i alogliptin and the SGLT2is canagliflozin, dapagliflozin, and empagliflozin were compared by Vlacho et al 26 . The percentage of subjects, which were adherent to alogliptin (72.7%) was comparable to that of canagliflozin (73.7%) and dapagliflozin (71.7%) 26 . However, the percentage of subjects, adherent to alogliptin, was based on 22 subjects 26 .…”

Section: Resultsmentioning

confidence: 99%

“…However, the duration of the treatmentfree period used to define treatment discontinuation, varied across the studies, spanning from 60 to 184 days [23][24][25][26][27] (Table 3). Treatment discontinuation was defined as a change in the type of OAD by Jermendy et al, 24 Rea et al, 25 Strain et al, 23 and Vlacho et al, 26 whereas Wilding et al 27 MPR is defined as the ratio between the number of days a patient is supplied with the given medication and the number of days between each medication refill over a given time span. 28 It expresses the percentage of time that a subject has the medication available 28 and is, thus, a proxy for treatment adherence.…”

Section: Measurement Methodsmentioning

confidence: 99%

“…The size of each point represents the number of subjects in treatment with the given second-line OAD. MPR, medication possession ratio; DPP4i, dipeptidyl peptidase 4 inhibitor; SGLT2i, sodium-glucose cotransporter 2 inhibitor.Gordon, et al[21] Strain, et al[23] Vlacho, et al[26] Vlacho, et al[26] Vlacho, et al[26] Vlacho, et al[26]…”

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confidence: 99%

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Adherence to newer second‐line oral antidiabetic drugs among people with type 2 diabetes—A systematic review

Holdt‐Caspersen,

Dethlefsen,

Vestergaard

et al. 2024

Pharmacology Res & Perspec

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The adherence to oral antidiabetic drugs (OADs) among people with type 2 diabetes (T2D) is suboptimal. However, new OADs have been marketed within the last 10 years. As these new drugs differ in mechanism of action, treatment complexity, and side effects, they may influence adherence. Thus, the aim of this study was to assess the adherence to newer second‐line OADs, defined as drugs marketed in 2012–2022, among people with T2D. A systematic review was performed in CINAHL, Cochrane Trials, Embase, PubMed, PsycINFO, and Scopus. Articles were included if they were original research of adherence to newer second‐line OADs and reported objective adherence quantification. The quality of the articles was assessed using JBI's critical appraisal tools. The overall findings were reported according to the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines and summarized in a narrative synthesis. All seven included articles were European retrospective cohort studies investigating alogliptin, canagliflozin, dapagliflozin, empagliflozin, and unspecified types of SGLT2i. Treatment discontinuation and medication possession ratio (MPR) were the most frequently reported adherence quantification measures. Within the first 12 months of treatment, 29%–44% of subjects on SGLT2i discontinued the treatment. In terms of MPR, 61.7%–94.9% of subjects on either alogliptin, canagliflozin, dapagliflozin, empagliflozin or an unspecified SGLT2i were adherent. The two investigated adherence quantification measures, treatment discontinuation and MPR, suggest that adherence to the newer second‐line OADs may be better than that of older OADs. However, a study directly comparing older and newer OADs should be done to verify this.

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Section: Discussionmentioning

confidence: 59%

Section: Resultsmentioning

confidence: 99%

Section: Measurement Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Adherence to newer second‐line oral antidiabetic drugs among people with type 2 diabetes—A systematic review

Holdt‐Caspersen,

Dethlefsen,

Vestergaard

et al. 2024

Pharmacology Res & Perspec

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“…This sequence allows us to better model the drug exposition and detect discontinuations, switches, and periods of interaction with other drugs of short duration. In addition, it can be of great help in estimating adherence to a combination treatment [ 30 ]. With the smooth algorithm, we can easily calculate the exposure time using only electronic prescriptions without the need to know the dosage posology.…”

Section: Discussionmentioning

confidence: 99%

Automatic Estimation of the Most Likely Drug Combination in Electronic Health Records Using the Smooth Algorithm: Development and Validation Study

Ouchi¹,

Giner-Soriano²,

Gómez-Lumbreras³

et al. 2022

JMIR Med Inform

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Background Since the use of electronic health records (EHRs) in an automated way, pharmacovigilance or pharmacoepidemiology studies have been used to characterize the therapy using different algorithms. Although progress has been made in this area for monotherapy, with combinations of 2 or more drugs the challenge to characterize the treatment increases significantly, and more research is needed. Objective The goal of the research was to develop and describe a novel algorithm that automatically returns the most likely therapy of one drug or combinations of 2 or more drugs over time. Methods We used the Information System for Research in Primary Care as our reference EHR platform for the smooth algorithm development. The algorithm was inspired by statistical methods based on moving averages and depends on a parameter Wt, a flexible window that determines the level of smoothing. The effect of Wt was evaluated in a simulation study on the same data set with different window lengths. To understand the algorithm performance in a clinical or pharmacological perspective, we conducted a validation study. We designed 4 pharmacological scenarios and asked 4 independent professionals to compare a traditional method against the smooth algorithm. Data from the simulation and validation studies were then analyzed. Results The Wt parameter had an impact over the raw data. As we increased the window length, more patient were modified and the number of smoothed patients augmented, although we rarely observed changes of more than 5% of the total data. In the validation study, significant differences were obtained in the performance of the smooth algorithm over the traditional method. These differences were consistent across pharmacological scenarios. Conclusions The smooth algorithm is an automated approach that standardizes, simplifies, and improves data processing in drug exposition studies using EHRs. This algorithm can be generalized to almost any pharmacological medication and model the drug exposure to facilitate the detection of treatment switches, discontinuations, and terminations throughout the study period.

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Impact of Second-Line Combination Treatment for Type 2 Diabetes Mellitus on Disease Control: A Population-Based Cohort Study

Ouchi

Vilaplana-Carnerero

Monfà

et al. 2023

Drugs - Real World Outcomes

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Background Type 2 diabetes mellitus is a chronic disease affecting millions of people worldwide. Achieving and maintaining glycemic control is essential to prevent or delay complications and different strategies are available as second-line treatment options for patients with type 2 diabetes who do not achieve glycemic control with metformin monotherapy. Objective The aim of this work is to describe the impact of initiating a combination treatment to reduce glycated hemoglobin in patients with type 2 diabetes with insufficient glycemic control. Methods We included patients with a type 2 diabetes diagnosis between 2015 and 2020 at the Information System for Research in Primary Care (SIDIAP) database in Catalonia, Spain. The primary outcome was the time to glycated hemoglobin control (≤ 7%) during the first 720 days, expressed as the restricted mean survival time. Adjusted differences of the restricted mean survival time were compared to analyze the performance of each treatment versus the combination with a sulfonylurea. Adherence was calculated as the medication possession ratio using an algorithm to model treatment exposure. Results A total of 28,425 patients were analyzed. The most frequent combinations were those with sulfonylureas and dipeptidyl peptidase-4 inhibitors. All treatments reduced glycated hemoglobin and the restricted mean survival time for the sulfonylurea treatment was 455 (451–459) days although combinations with glucagon-like peptide-1 and insulin reached glycemic control earlier, − 126 days (− 152 to − 100, p < 0.001) and − 69 days (− 88 to − 50, p < 0.001), respectively. Adherence was high in all groups apart from the insulin combination and had a significant effect in reducing glycated hemoglobin except in sodium-glucose cotransporter type 2 inhibitors and insulin. Glucagon-like peptide-1 and sodium-glucose cotransporter type 2 inhibitors showed significant reductions in weight. Conclusions Patients achieved the glycated hemoglobin goal with second-line treatments. Glucagon-like peptide-1 and insulin combinations achieved the goal earlier than sulfonylurea combinations. Adherence significantly reduced the time to glycated hemoglobin control except for the combination with sodium-glucose cotransporter type 2 inhibitors. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-023-00374-2.

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Analysis of the Adherence and Safety of Second Oral Glucose-Lowering Therapy in Routine Practice From the Mediterranean Area: A Retrospective Cohort Study

Cited by 8 publications

References 41 publications

Adherence to newer second‐line oral antidiabetic drugs among people with type 2 diabetes—A systematic review

Adherence to newer second‐line oral antidiabetic drugs among people with type 2 diabetes—A systematic review

Automatic Estimation of the Most Likely Drug Combination in Electronic Health Records Using the Smooth Algorithm: Development and Validation Study

Impact of Second-Line Combination Treatment for Type 2 Diabetes Mellitus on Disease Control: A Population-Based Cohort Study

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