PMID- 31880221 OWN - NLM STAT- MEDLINE DCOM- 20200601 LR - 20240403 IS - 2376-1032 (Electronic) IS - 2376-0540 (Print) IS - 2376-0540 (Linking) VI - 26 IP - 1 DP - 2020 Jan TI - Adherence and Persistence with DPP-4 Inhibitors Versus Pioglitazone in Type 2 Diabetes Patients with Chronic Kidney Disease: A Retrospective Claims Database Analysis. PG - 67-75 LID - 10.18553/jmcp.2020.26.1.67 [doi] AB - BACKGROUND: Adherence and persistence with diabetes medication play an important role in glycemic control and may differ by medication class. However, there is a lack of research comparing diabetes medications in patients with renal impairment, despite the challenges and higher burden associated with managing this population. OBJECTIVE: To compare adherence and persistence among patients with type 2 diabetes mellitus (T2DM) and nondialysis chronic kidney disease (CKD) treated with dipeptidyl peptidase-4 (DPP-4) inhibitors versus pioglitazone. METHODS: This retrospective cohort study used Truven MarketScan administrative claims databases from 2009 to 2015. One-year adherence for patients with T2DM and nondialysis CKD who initiated therapy with either a DPP-4 inhibitor or pioglitazone was measured by proportion of days covered (PDC) following an initial dispensing, and PDC >/= 0.80 was coded as adherent. Persistence was calculated as the days between the index date and last day with the index medication on hand, based on the end of the last days supply or the end of follow-up (i.e., 365 days), whichever occurred first. Multivariate logistic regression and Cox proportional hazards models were used to estimate confounder-adjusted differences between the groups for adherence and persistence. RESULTS: The final cohort included 9,019 patients (DPP-4 inhibitors: 7,002; pioglitazone: 2,017). In the adjusted analysis, DPP-4 inhibitor users demonstrated a 1.41 (95% CI = 1.25-1.59) higher odds of being adherent compared with pioglitazone users. Overall adjusted HR for persistence was 0.74 (95% CI = 0.69-0.79), which favored DPP-4 inhibitors compared with pioglitazone. Relative to 2010, persistence with pioglitazone decreased in 2011-2012 and then increased in 2013-2014. In the subgroup analysis, DPP-4 inhibitors first had lower (2010: OR = 0.78, 95% CI = 0.70-0.87; 2011-2012: OR = 0.60, 95% CI = 0.54-0.66) and then similar (2013-2014: OR = 1.03, 95% CI = 0.88-1.19) hazards of nonpersistence compared with pioglitazone. CONCLUSIONS: Among patients with T2DM and nondialysis CKD, the use of DPP-4 inhibitors was associated with better adherence compared with pioglitazone. However, following the approval of generic pioglitazone and associated lower cost sharing after 2012, the magnitude of difference in adherence between the medication classes reduced. Similarly, safety warnings in 2011 and approval of generic products in 2012 may have affected pioglitazone persistence, leading to first higher and then similar hazards for nonpersistence with pioglitazone as compared with DPP-4 inhibitors. These shifts in the results for pioglitazone warrant further investigation and close monitoring of the population initiating this medication. DISCLOSURES: No funding was received for this study. The authors have no conflicts of interest to disclose. An abstract for this study was presented as a podium presentation at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) 2019 Annual Meeting; May 18-22, 2019; New Orleans, LA. FAU - Gor, Deval AU - Gor D AD - Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago. FAU - Lee, Todd A AU - Lee TA AD - Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago. FAU - Schumock, Glen T AU - Schumock GT AD - Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago. FAU - Walton, Surrey M AU - Walton SM AD - Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago. FAU - Gerber, Ben S AU - Gerber BS AD - Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago. FAU - Nutescu, Edith A AU - Nutescu EA AD - Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago. FAU - Touchette, Daniel R AU - Touchette DR AD - Department of Pharmacy Systems, Outcomes and Policy, and Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago. LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - J Manag Care Spec Pharm JT - Journal of managed care & specialty pharmacy JID - 101644425 RN - 0 (Dipeptidyl-Peptidase IV Inhibitors) RN - 0 (Drugs, Generic) RN - 0 (Hypoglycemic Agents) RN - X4OV71U42S (Pioglitazone) SB - IM MH - Administrative Claims, Healthcare MH - Aged MH - Diabetes Mellitus, Type 2/diagnosis/*drug therapy/epidemiology MH - Dipeptidyl-Peptidase IV Inhibitors/adverse effects/*therapeutic use MH - Disease Progression MH - Drug Substitution MH - Drug Utilization MH - Drugs, Generic/adverse effects/*therapeutic use MH - Female MH - Humans MH - Hypoglycemic Agents/adverse effects/*therapeutic use MH - Insurance, Pharmaceutical Services MH - Male MH - *Medication Adherence MH - Middle Aged MH - Pioglitazone/adverse effects/*therapeutic use MH - *Practice Patterns, Physicians' MH - Renal Insufficiency, Chronic/diagnosis/*drug therapy/epidemiology MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - United States/epidemiology PMC - PMC10390941 COIS- No funding was received for this study. The authors have no conflicts of interest to disclose. An abstract for this study was presented as a podium presentation at the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) 2019 Annual Meeting; May 18-22, 2019; New Orleans, LA. EDAT- 2019/12/28 06:00 MHDA- 2020/06/02 06:00 PMCR- 2020/01/01 CRDT- 2019/12/28 06:00 PHST- 2019/12/28 06:00 [entrez] PHST- 2019/12/28 06:00 [pubmed] PHST- 2020/06/02 06:00 [medline] PHST- 2020/01/01 00:00 [pmc-release] AID - 10.18553/jmcp.2020.26.1.67 [doi] PST - ppublish SO - J Manag Care Spec Pharm. 2020 Jan;26(1):67-75. doi: 10.18553/jmcp.2020.26.1.67.