1092-P: Treatment Changes Post–Second-Line Medication Initiation, a Real-World Retrospective Cohort Study

Abstract

Objective: This study used real-world data to describe treatment patterns in second-line antidiabetic medication (ADM) regimen (Sulfonylureas, DPP-4 inhibitors, GLP-1 RAs, SGLT2 inhibitors, or TZDs) over a fixed 12 month follow-up period. Methods: Medical and pharmacy claims were used to identify adult commercial and Medicare Advantage Part D health plan enrollees with T2DM initiating second-line ADMs between 2013-2016. The primary outcome was the first pharmacy claim indicating a change in regimen: switch to a new ADM class; treatment discontinuation (gap ≥30 days); or intensification (≥doubling of dose, adding a new ADM class, or switching to/adding insulin). Patients were classified as adherent if no change was observed. Results: Of 73,290 study subjects with 2LADM, 53% were Sulfonylurea, 26% were DPP-4, 7% were GLP-1 RA, 9% SGLT2, and 5% TZD. Changes in treatment within 1 year were observed for over 70% of all patients (Table). There was little switching, about 50% discontinued their 2LADM with the highest rate of discontinuation among those receiving GLP-1 RAs and lowest among those receiving TZDs. About 20% of patients intensified medication regimen. Discussion: The very high rate of observed treatment changes, in particular discontinuation, may indicate that patients face multiple barriers to treatment adherence. Real-world studies can inform patient-centered treatment selection. Disclosure S. Pasricha: None. M. Cherupally: None. E. Koep: Employee; Self; UnitedHealth Group. R.T. Ackermann: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, UnitedHealth Group. C. Aikman: None. A.J. Cooper: None. M. O’Brien: Research Support; Self; UnitedHealth Group. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. D.T. Liss: None. E.D. Parker: None. Funding UnitedHealth Services (SP0036847)