PMID- 31264097 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1869-6953 (Print) IS - 1869-6961 (Electronic) IS - 1869-6961 (Linking) VI - 10 IP - 4 DP - 2019 Aug TI - Retrospective Database Analysis Evaluating the Clinical Outcomes of Changing Treatment of People with Type 2 Diabetes Mellitus (T2DM) from Other DPP-4 Inhibitor Therapy to Alogliptin in a Primary Care Setting. PG - 1499-1507 LID - 10.1007/s13300-019-0662-y [doi] AB - INTRODUCTION: Although some differences between individual dipeptidyl peptidase-4 (DPP-4) inhibitors may exist, the National Institute for Health and Clinical Excellence (NICE) have recommended that 'prescribers should be encouraged to select the individual DPP-4 inhibitor with the lowest acquisition cost available to them, where all other factors are equal'. We aimed to determine whether or not 'within class' switching to alogliptin, the DPP-4 inhibitor with lowest acquisition cost, is a clinically appropriate strategy. METHODS: This study evaluated people with type 2 diabetes taking DPP-4 inhibitor therapy in addition to at least one other diabetes therapy. Primary care records were reviewed from six clinical commissioning groups (CCGs). For people who had been switched from other DPP-4 inhibitors to alogliptin, an assessment of the impact of switch on both absolute haemoglobin A1c (HbA1c) levels and on HbA1c trajectory was undertaken. Persistence on alogliptin and the need for therapy intensification was also assessed. RESULTS: Overall, 865 people with diabetes met the eligibility criteria for the study. There was no significant difference between pre- and post-switch mean HbA1c level [8.44% (SD 1.52%) vs 8.42% (1.62%), p = 0.6]. Similarly, for patients where there was sufficient data to assess the impact of switching on HbA1c trajectory (n = 319) minimal impact was identified (actual HbA1c at 3 months 8.33% vs projected 8.31%). The majority of people with diabetes (80.76%) remained on alogliptin treatment at 6 months and only 4.54% required additional diabetes therapies. Switching to alogliptin resulted in a median saving of pound7.24 per patient-month. CONCLUSION: Switching United Kingdom (UK) primary care patients from other DPP-4 inhibitors to alogliptin did not result in a statistically significant or clinically meaningful change in HbA1c level and few required the addition of further diabetes therapies, suggesting that therapy change or intensification was not considered necessary in most patients who were switched to alogliptin. TRIAL REGISTRATION: ENCePP clinical trial registration number EUPAS29153. FUNDING: Takeda UK Ltd. FAU - Strain, W David AU - Strain WD AUID- ORCID: 0000-0002-6826-418X AD - Diabetes and Vascular Medicine Research, University of Exeter Medical School, Exeter, UK. d.strain@exeter.ac.uk. FAU - McEwan, Phil AU - McEwan P AD - Health Economics and Outcomes Research Ltd, Cardiff Gate Business Park, Cardiff, UK. FAU - Howitt, Heena AU - Howitt H AD - Takeda UK Ltd, Glory Park, Wooburn Green, Bucks, UK. FAU - Meadowcroft, Simon AU - Meadowcroft S AD - Takeda UK Ltd, Glory Park, Wooburn Green, Bucks, UK. LA - eng PT - Journal Article DEP - 20190701 PL - United States TA - Diabetes Ther JT - Diabetes therapy : research, treatment and education of diabetes and related disorders JID - 101539025 PMC - PMC6612350 OTO - NOTNLM OT - Clinical effectiveness OT - DPP-4 inhibitors OT - Health economics OT - Real-world evidence EDAT- 2019/07/03 06:00 MHDA- 2019/07/03 06:01 PMCR- 2019/07/01 CRDT- 2019/07/03 06:00 PHST- 2019/05/03 00:00 [received] PHST- 2019/07/03 06:00 [pubmed] PHST- 2019/07/03 06:01 [medline] PHST- 2019/07/03 06:00 [entrez] PHST- 2019/07/01 00:00 [pmc-release] AID - 10.1007/s13300-019-0662-y [pii] AID - 662 [pii] AID - 10.1007/s13300-019-0662-y [doi] PST - ppublish SO - Diabetes Ther. 2019 Aug;10(4):1499-1507. doi: 10.1007/s13300-019-0662-y. Epub 2019 Jul 1.