1076-P: First-Fill Failure with Antihyperglycemic Medications: A Systematic Literature Review

Abstract

Introduction: Antihyperglycemic medications are often a necessary component of diabetes treatment to achieve adequate glycemic control and reduce the risk of complications. First fill failure (FFF) occurs when a patient does not obtain a newly prescribed medication and therefore does not take even the first dose. This phenomenon is an important clinical consideration, and the objective of this study is to summarize the evidence describing FFF with antihyperglycemic medications. Methods: A systematic literature review using Medline (PubMed) identified articles from 2010-2019 that researched FFF to antihyperglycemic medications. To be included, studies must have reported on the prevalence, associated factors, or patient-reported reasons. Studies that solely evaluated non-adult populations, employed weaker study designs (i.e., case reports/series), performed interventions, were conducted outside of the USA, or were not written in English were excluded. Results: The search identified 2,289 unique articles from which 11 studies were included. Estimates of the prevalence of FFF to new antihyperglycemic medications (n=8 studies) ranged from 9-21% of patients, and 1-54% of prescriptions. Results varied due to differences in study populations, data sources and whether “new prescription” was defined as no prior history of the specific medication or the medication class. Associated with FFF (n=2 studies) were higher out-of-pocket costs for the antihyperglycemic medication, non-English speaking, and non-white race/ethnicity. Patient-reported reasons for FFF (n=2 studies) included not believing the medication was needed or planning to improve health behaviors, financial burden, and concern for side effects. Conclusion: Up to one-fifth of patients are unsuccessful in initiating a newly prescribed antihyperglycemic medication. Addressing the reasons behind FFF may improve medication initiation and contribute to better health and outcomes of those with diabetes. Disclosure N. M. Ahmed: None. S. Peters: None. C. E. Cooke: None.