Adherence, Persistence, and Switching Among People Prescribed Sodium Glucose Co-transporter 2 Inhibitors: A Nationwide Retrospective Cohort Study

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.

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Acknowledgements

The authors are grateful to the Australian Government Department of Human Services for providing the Pharmaceutical Benefits Scheme (PBS) data set that was used in this study.

Funding

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

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Danny Liew 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. Dianna J. Magliano reports past participation in advisory boards and/or receiving honoraria from AstraZeneca and Bayer for work unrelated to this study. Richard Ofori-Asenso is now also affilitated with Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Samanta Lalic, Mohsen Mazidi, Zanfina Ademi, J. Simon Bell and Jenni Ilomaki have nothing to disclose.

Compliance with Ethics Guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors; as such, informed consent of individuals was not required. The study was approved by the Monash University Human research Ethics Committee and the analysis plan was noted by the Australian Government Department of Human Services.

Data Availability

The data used for the analysis can be obtained by direct application to the Australian Government department of Health.

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Correspondence to Richard Ofori-Asenso.

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Ofori-Asenso, R., Liew, D., Lalic, S. et al. Adherence, Persistence, and Switching Among People Prescribed Sodium Glucose Co-transporter 2 Inhibitors: A Nationwide Retrospective Cohort Study. Adv Ther 36, 3265–3278 (2019). https://doi.org/10.1007/s12325-019-01077-3

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Keywords

  • Adherence
  • Australia
  • Diabetes
  • Persistence
  • SGLT2 inhibitors
  • Switching