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Comparison of medication persistence and adherence in type 2 diabetes using a once-weekly regimen of DPP-4 inhibitor compared with once-daily and twice-daily regimens: a retrospective cohort study of Japanese health insurance claims data

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Abstract

Aims

Assess medication persistence and adherence for dipeptidyl peptidase-4 inhibitors (DPP-4i) administered once weekly (QW), once daily (QD), and twice daily (BID) among patients with type 2 diabetes (T2D), and explore factors associated with discontinuation and non-adherence for DPP-4i regimens.

Methods

This retrospective T2D cohort study used medical claims data for three DPP-4i regimens in patients newly prescribed DPP-4i between December 2016 and February 2019. Medication persistence rates were calculated at 3, 6, and 12 months by the Kaplan–Meier method. Adherence was measured as Proportion of Days Covered (PDC). We used Cox proportional hazards models for DPP-4i discontinuation and logistic regression models for non-adherence.

Results

In the analysis population of 52,762 patients, DPP-4i prescriptions were 84.2% QD, 11.8% BID, and 4.0% QW. Medication persistence rates were similar up to 6 months for all regimens: approximately 90% at 3 and 80% at 6 months. The 12-month persistence rates for QD, BID, and QW were 74.8%, 67.5%, and 68.0%, respectively. Median PDC was 94.0% for QD, 91.8% for BID, and 93.2% for QW. Five specific factors were associated with discontinuation: BID or QW regimen, younger age, no concomitant medications, comorbid dementia, and comorbid chronic pulmonary disease. Non-adherence was associated with those factors plus male sex and treatment at clinics with 0–19 beds.

Conclusions

The 12-month medication persistence rates were highest for QD, followed by QW and then BID. Adherence was similar for all three regimens. Medication persistence for DPP-4i may be improved by tailoring regimens to patient characteristics and needs.

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Data availability

The datasets generated and/or analyzed during the current study were obtained from data accessed under license with DeSC Healthcare Inc. (Tokyo, Japan) and are not publicly available due to restrictions placed by DeSC Healthcare Inc. on the use of that data.

Change history

  • 10 April 2024

    Supplementary Figure 2 was cross linked incorrectly with Figure 2 and cross link was removed in this version.

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Acknowledgements

Review of the statistical analysis plan and statistical analysis was supported by Koji Ashizawa, affiliated with Takumi Information Technology Inc. Medical writing support was provided by EDIT, Inc. (Tokyo, Japan) and was funded by Teijin Pharma Limited.

Funding

This study was supported by Teijin Pharma Limited.

Author information

Authors and Affiliations

  1. Medical Science Department, Teijin Pharma Limited, 2-1, Kasumigaseki 3-chome, Chiyoda-ku, Tokyo, 100-8585, Japan

    Tetsuya Miwa & Ruriko Koto

  2. Clinical Development Control Department, Teijin Pharma Limited, Tokyo, Japan

    Shiori Yoshida & Akihiro Nakajima

  3. Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

    Rimei Nishimura

Authors
  1. Tetsuya Miwa
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  2. Shiori Yoshida
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  3. Akihiro Nakajima
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  4. Ruriko Koto
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  5. Rimei Nishimura
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Shiori Yoshida and Akihiro Nakajima. Rimei Nishimura confirmed the validity of the study design and interpretation of the results from a medical perspective. The first draft of the manuscript was written by Tetsuya Miwa, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tetsuya Miwa.

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Conflict of interest

TM, SY, AN, and RK are employees of Teijin Pharma Limited. RN has received honoraria from Astellas Pharma Inc., Astra Zeneca K.K., Boehringer Ingelheim Japan, Inc., Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Co., Ltd., Medtronic Japan Co., Ltd., Novo Nordisk Pharma Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Sumitomo Pharma Co., Ltd., and Abbott Japan LLC; research funding from Mitsubishi Electric Corp.; and subsidies or donations from Abbott Japan LLC, Boehringer Ingelheim Japan, Inc., Eli Lilly Japan K.K., Sumitomo Pharma Co., Ltd., Arkley Inc., and Taisho Pharmaceutical Co., Ltd.

Ethical approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Patient consent

Because the data used in this study came from a large health insurance claims database and were fully anonymized, there was no need for informed consent from individual patients or approval from the Institutional Review Board (IRB).

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Miwa, T., Yoshida, S., Nakajima, A. et al. Comparison of medication persistence and adherence in type 2 diabetes using a once-weekly regimen of DPP-4 inhibitor compared with once-daily and twice-daily regimens: a retrospective cohort study of Japanese health insurance claims data. Diabetol Int (2024). https://doi.org/10.1007/s13340-024-00714-9

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