Abstract
BackgroundThe patterns and determinants of saxagliptin use among patients with type 2 diabetes mellitus (T2DM) are unknown in real-world settings. We compared the characteristics of T2DM patients who were new initiators of saxagliptin to those who were new initiators of non-dipeptidyl peptidase-4 (DPP-4) inhibitor oral anti-diabetic drugs (OADs) and identified factors associated with saxagliptin use.MethodsWe conducted a cross-sectional study within the Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), US Medicare, and the HealthCore Integrated Research Database (HIRDSM) across the first 36 months of saxagliptin availability (29 months for US Medicare). Patients were included if they were: 1) ≥18 years old, 2) newly prescribed saxagliptin or a non-DPP-4 inhibitor OAD, and 3) enrolled in their respective database for 180 days. For each saxagliptin initiator, we randomly selected up to ten non-DPP-4 inhibitor OAD initiators matched on age, sex, and geographic region. Conditional logistic regression was used to identify determinants of saxagliptin use.ResultsWe identified 64,079 saxagliptin initiators (CPRD: 1,962; THIN: 2,084; US Medicare: 51,976; HIRDSM: 8,057) and 610,660 non-DPP-4 inhibitor OAD initiators (CPRD: 19,484; THIN: 19,936; US Medicare: 493,432; HIRDSM: 77,808). Across all four data sources, prior OAD use, hypertension, and hyperlipidemia were associated with saxagliptin use. Saxagliptin initiation was also associated with hemoglobin A1c results >8% within the UK data sources, and a greater number of hemoglobin A1c measurements in the US data sources.ConclusionsIn these UK and US data sources, initiation of saxagliptin was associated with prior poor glycemic control, prior OAD use, and diagnoses of hypertension and hyperlipidemia.Trial registrationClinicalTrials.gov identifiers NCT01086280, NCT01086293, NCT01086319, NCT01086306, and NCT01377935
Highlights
The patterns and determinants of saxagliptin use among patients with type 2 diabetes mellitus (T2DM) are unknown in real-world settings
Since the effectiveness and safety of saxagliptin and other Oral anti-diabetic drug (OAD) therapies may be affected by demographic characteristics, medical comorbidities, and additional medications prescribed to T2DM patients, identifying the factors associated with the use of particular OADs in real-world settings can provide important information needed for the future conduct of studies evaluating the comparative effectiveness and safety of anti-diabetic drugs
Patient characteristics United Kingdom (UK) data sources Within The Health Improvement Network (THIN) and Clinical Practice Research Datalink (CPRD), respectively, we identified, 1,962 and 2,084 new initiators of saxagliptin (Figure 1a and b) as well as 19,484 and 19,936 matched new initiators of non-dipeptidyl peptidase-4 (DPP-4) inhibitor OADs
Summary
The patterns and determinants of saxagliptin use among patients with type 2 diabetes mellitus (T2DM) are unknown in real-world settings. Since the effectiveness and safety of saxagliptin and other OAD therapies may be affected by demographic characteristics, medical comorbidities, and additional medications prescribed to T2DM patients, identifying the factors associated with the use of particular OADs in real-world settings can provide important information needed for the future conduct of studies evaluating the comparative effectiveness and safety of anti-diabetic drugs. Such variables can be incorporated within propensity scores to help to minimize confounding by indication [16,17]
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