Richard Ofori-Asenso1, Danny Liew2, Samanta Lalic3, Mohsen Mazidi4, Dianna J Magliano2,5, Zanfina Ademi2, J Simon Bell2,3,6, Jenni Ilomaki2,3. 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. richard.ofori-asenso@monash.edu. 2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 3. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia. 4. Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden. 5. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. 6. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
Abstract
INTRODUCTION: Non-adherence and non-persistence to diabetes medications are associated with worse clinical outcomes. In this study, we aimed to characterise the 1-year switching, adherence, and persistence patterns among people with diabetes aged 18 years and older prescribed sodium-glucose co-transporter 2 inhibitors (SGLT2is) in Australia. METHODS: Using data from Australia's national Pharmaceutical Benefits Scheme (PBS), we identified 11,981 adults (mean age 60.9 years; 40.5% female) newly initiated on SGLT2is (5993 dapagliflozin; 5988 empagliflozin) from September 2015 to August 2017. Adherence was assessed via the proportion of days covered (PDC), persistence was defined as the continuous use of SGLT2i without a gap of ≥ 90 days, and switching was defined as the first change from dapagliflozin to empagliflozin or vice versa. Generalised linear models (GLMs) were used to compare the adherence (PDC = continuous), logistic regression models were used to compare the likelihoods of being adherent (PDC ≥ 0.80), and Cox proportional hazard models were used to compare the likelihoods of persistence and switching between people prescribed empagliflozin and dapagliflozin. RESULTS: Overall, 65.8% (7879/11,981) of people dispensed SGLT2is were adherent (PDC ≥ 0.80) and 72.1% (8644/11,981) were persistent at 12 months. The mean PDC was 0.79 ± 0.27. The use of empagliflozin was associated with higher adherence (PDC = continuous) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.03-1.05], being adherent (OR 1.39, 95% CI 1.29-1.51), and persisting for 12 months [hazard ratio (HR) 1.14, 95% CI 1.06-1.22] compared with dapagliflozin. Only 4.3% (509/11,981) of people switched between the SGLT2i. Compared with dapagliflozin, people initiated on empagliflozin were less likely to switch [HR 0.46, 95% CI 0.38-0.55]. CONCLUSIONS: A considerable proportion of Australians prescribed SGLT2is were non-adherent or non-persistent. However, empagliflozin was associated with better adherence and persistence rates and a lower likelihood of switching compared with dapagliflozin.
INTRODUCTION: Non-adherence and non-persistence to diabetes medications are associated with worse clinical outcomes. In this study, we aimed to characterise the 1-year switching, adherence, and persistence patterns among people with diabetes aged 18 years and older prescribed sodium-glucose co-transporter 2 inhibitors (SGLT2is) in Australia. METHODS: Using data from Australia's national Pharmaceutical Benefits Scheme (PBS), we identified 11,981 adults (mean age 60.9 years; 40.5% female) newly initiated on SGLT2is (5993 dapagliflozin; 5988 empagliflozin) from September 2015 to August 2017. Adherence was assessed via the proportion of days covered (PDC), persistence was defined as the continuous use of SGLT2i without a gap of ≥ 90 days, and switching was defined as the first change from dapagliflozin to empagliflozin or vice versa. Generalised linear models (GLMs) were used to compare the adherence (PDC = continuous), logistic regression models were used to compare the likelihoods of being adherent (PDC ≥ 0.80), and Cox proportional hazard models were used to compare the likelihoods of persistence and switching between people prescribed empagliflozin and dapagliflozin. RESULTS: Overall, 65.8% (7879/11,981) of people dispensed SGLT2is were adherent (PDC ≥ 0.80) and 72.1% (8644/11,981) were persistent at 12 months. The mean PDC was 0.79 ± 0.27. The use of empagliflozin was associated with higher adherence (PDC = continuous) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.03-1.05], being adherent (OR 1.39, 95% CI 1.29-1.51), and persisting for 12 months [hazard ratio (HR) 1.14, 95% CI 1.06-1.22] compared with dapagliflozin. Only 4.3% (509/11,981) of people switched between the SGLT2i. Compared with dapagliflozin, people initiated on empagliflozin were less likely to switch [HR 0.46, 95% CI 0.38-0.55]. CONCLUSIONS: A considerable proportion of Australians prescribed SGLT2is were non-adherent or non-persistent. However, empagliflozin was associated with better adherence and persistence rates and a lower likelihood of switching compared with dapagliflozin.
Authors: Chelsea E Hawley; Julie C Lauffenburger; Julie M Paik; Deborah J Wexler; Seoyoung C Kim; Elisabetta Patorno Journal: Diabetes Care Date: 2022-03-01 Impact factor: 19.112
Authors: Jenni Ilomäki; J Simon Bell; Adrienne Y L Chan; Anna-Maija Tolppanen; Hao Luo; Li Wei; Edward Chia-Cheng Lai; Ju-Young Shin; Giorgia De Paoli; Romin Pajouheshnia; Frederick K Ho; Lorenna Reynolds; Kui Kai Lau; Stephen Crystal; Wallis C Y Lau; Kenneth K C Man; Ruth Brauer; Esther W Chan; Chin-Yao Shen; Ju Hwan Kim; Terry Y S Lum; Sirpa Hartikainen; Marjaana Koponen; Evelien Rooke; Marloes Bazelier; Olaf Klungel; Soko Setoguchi; Jill P Pell; Sharon Cook; Ian C K Wong Journal: CNS Drugs Date: 2020-09 Impact factor: 5.749