(PO-4466) Real-world Treatment Patterns And Adherence Of First-line Anti-diabetic Treatments Among T2dm Patients Using Japanese Claims Data
Monday, September 14, 2020
Jocelyn Ruoyi Wang, Amanda Patrick, Pattra Mattox and Ashley Jaksa
Background: Global regulatory agencies traditionally use randomized-controlled trials (RCT) to inform decisions. However, a discrepancy often exists between pre-marketing RCT efficacy data and the effectiveness data from real-world evidence (RWE). The Japan Clinical Practice Guideline for Diabetes recommends individualizing first-line treatment with an oral hypoglycemic agent based on patient conditions and safety profiles. Furthermore, medication adherence is critical to ensuring long-term glycemic control.
Objectives: To understand the treatment pathways and real-world adherence to anti-glycemic agents among type-2 diabetic (T2D) patients using a Japanese administrative database.
Methods: We identified newly-diagnosed T2D patients initiating first-line treatment using the Japanese Medical Data Center (JMDC) claims database (2014-2018). JMDC includes inpatient, outpatient, pharmacy claims and Diagnosis Procedure Combination (DPC) codes. Patients <18 years and those with prior anti-diabetic treatment were excluded. Patients were assessed for adherence (proportion of days covered [PDC]>80%) and persistence (i.e., probability of persistency during the assessment period) of first-line treatment during a one-year follow-up. Treatment change (addition, switching, and/or discontinuation) was also evaluated.
Results: Among 5,583 patients, the mean age was 55 years; 71.1% were male. Transition-based treatment pathway showed that dipeptidyl peptidase 4 inhibitors (DPP4i 49.5%) was the most common first-line treatment, followed by metformin (26.6%), and SGLT2-i (10.1%). Nine different treatment pathways were observed for second-line therapy intensification. One-year persistence ranged from 29%-62%; SLGT2-i (62%) and DPP4-i (53%) users had the highest persistence. PDC at one year ranged from 60%-84%, with the highest values in SGLT2-i (84%) and metformin (81%) users.
Conclusions: While most newly-diagnosed T2D patients in Japan received DPP4i as first-line treatment, DPP-4i adherence was suboptimal. New users of SGLT2i, the third most common first-line anti-glycemic, demonstrated higher adherence and persistence after one year of follow-up compared to the other antidiabetics. Complex treatment patterns of type-2 diabetic patients -- with frequent switching and less-than-optimal persistence -- highlights the utility of generating RWE from real-world data (RWD) sources to provide contextual information on routine clinical practice.