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Medication utilization patterns among type 2 diabetes patients initiating Exenatide BID or insulin glargine: a retrospective database study.

Pawaskar M, Bonafede M, Johnson B, Fowler R, Lenhart G, Hoogwerf B - BMC Endocr Disord (2013)

Bottom Line: Propensity score matching resulted in 3,774 matched pairs with a mean age of 57 years and a mean Deyo Charlson Comorbidity Index score of 1.6; 54% of patients were males.Alternatively, 14.9% of exenatide-treated patients switched therapies, compared to 10.0% of glargine-treated patients (p < 0.0001).Exenatide-treated patients were less likely to discontinue or modify treatment but more likely to switch therapy compared to glargine-treated patients.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Type 2 diabetes is a common and costly illness, associated with significant morbidity and mortality. Despite this, there is relatively little information on the 'real-world' medication utilization patterns for patients with type 2 diabetes initiating exenatide BID or glargine. The objective of this study was to evaluate the 'real-world' medication utilization patterns in patients with type 2 diabetes treated with exenatide BID (exenatide) versus insulin glargine (glargine).

Methods: Adult patients( ≥18 years of age) with type 2 diabetes who were new initiators of exenatide or glargine from October 1, 2006 through March 31, 2008 with continuous enrollment for the 12 months pre- and 18 months post-index period were selected from the MarketScan® Commercial and Medicare Databases. To control for selection bias, propensity score matching was used to complete a 1:1 match of glargine to exenatide patients. Key study outcomes (including the likelihood of overall treatment modification, discontinuation, switching, or intensification) were analyzed using survival analysis.

Results: A total of 9,197 exenatide- and 4,499 glargine-treated patients were selected. Propensity score matching resulted in 3,774 matched pairs with a mean age of 57 years and a mean Deyo Charlson Comorbidity Index score of 1.6; 54% of patients were males. The 18-month treatment intensification rates were 15.9% and 26.0% (p < 0.0001) and the discontinuation rates were 38.3% and 40.0% (p = 0.14) for exenatide and glargine, respectively. Alternatively, 14.9% of exenatide-treated patients switched therapies, compared to 10.0% of glargine-treated patients (p < 0.0001). Overall, glargine-treated patients were more likely to modify their treatment [hazard ratio (HR) = 1.33, p < 0.0001] with shorter mean time on treatment until modification (123 vs. 159 days, p < 0.0001). Compared to exenatide-treated patients, glargine-treated patients were more likely to discontinue [hazard ratio (HR) = 1.25, p < 0.0001] or intensify therapy (HR = 1.72, p < 0.0001) but less likely to switch (HR = 0.71, p < 0.0001) the index therapy.

Conclusions: Patients treated for type 2 diabetes with exenatide BID or insulin glargine differ in their adherence to therapy. Exenatide-treated patients were less likely to discontinue or modify treatment but more likely to switch therapy compared to glargine-treated patients.

No MeSH data available.


Related in: MedlinePlus

Treatment modification: Kaplan-Meier curves.
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Figure 1: Treatment modification: Kaplan-Meier curves.

Mentions: Compared to exenatide-treated patients, glargine-treated patients had lower treatment durability, demonstrated by higher rates of treatment modification and shorter time to treatment modification. Glargine-treated patients were 33% more likely to modify treatment [hazard ratio (HR) = 1.33, p < 0.0001]. Compared to exenatide-treated patients, a significantly higher percentage of glargine-treated patients experienced treatment modification in the 18 months post-index period (Table 2 and Figure 1). By 18 months, treatment modification was observed in 76.0% of the glargine cohort vs. 69.1% of the exenatide cohort (p < 0.0001). Patients initiating exenatide, were on their treatment longer before any modification compared to glargine-treated patients (159 vs. 123 days, p < 0.0001) indicating longer treatment durability.


Medication utilization patterns among type 2 diabetes patients initiating Exenatide BID or insulin glargine: a retrospective database study.

Pawaskar M, Bonafede M, Johnson B, Fowler R, Lenhart G, Hoogwerf B - BMC Endocr Disord (2013)

Treatment modification: Kaplan-Meier curves.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750447&req=5

Figure 1: Treatment modification: Kaplan-Meier curves.
Mentions: Compared to exenatide-treated patients, glargine-treated patients had lower treatment durability, demonstrated by higher rates of treatment modification and shorter time to treatment modification. Glargine-treated patients were 33% more likely to modify treatment [hazard ratio (HR) = 1.33, p < 0.0001]. Compared to exenatide-treated patients, a significantly higher percentage of glargine-treated patients experienced treatment modification in the 18 months post-index period (Table 2 and Figure 1). By 18 months, treatment modification was observed in 76.0% of the glargine cohort vs. 69.1% of the exenatide cohort (p < 0.0001). Patients initiating exenatide, were on their treatment longer before any modification compared to glargine-treated patients (159 vs. 123 days, p < 0.0001) indicating longer treatment durability.

Bottom Line: Propensity score matching resulted in 3,774 matched pairs with a mean age of 57 years and a mean Deyo Charlson Comorbidity Index score of 1.6; 54% of patients were males.Alternatively, 14.9% of exenatide-treated patients switched therapies, compared to 10.0% of glargine-treated patients (p < 0.0001).Exenatide-treated patients were less likely to discontinue or modify treatment but more likely to switch therapy compared to glargine-treated patients.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Type 2 diabetes is a common and costly illness, associated with significant morbidity and mortality. Despite this, there is relatively little information on the 'real-world' medication utilization patterns for patients with type 2 diabetes initiating exenatide BID or glargine. The objective of this study was to evaluate the 'real-world' medication utilization patterns in patients with type 2 diabetes treated with exenatide BID (exenatide) versus insulin glargine (glargine).

Methods: Adult patients( ≥18 years of age) with type 2 diabetes who were new initiators of exenatide or glargine from October 1, 2006 through March 31, 2008 with continuous enrollment for the 12 months pre- and 18 months post-index period were selected from the MarketScan® Commercial and Medicare Databases. To control for selection bias, propensity score matching was used to complete a 1:1 match of glargine to exenatide patients. Key study outcomes (including the likelihood of overall treatment modification, discontinuation, switching, or intensification) were analyzed using survival analysis.

Results: A total of 9,197 exenatide- and 4,499 glargine-treated patients were selected. Propensity score matching resulted in 3,774 matched pairs with a mean age of 57 years and a mean Deyo Charlson Comorbidity Index score of 1.6; 54% of patients were males. The 18-month treatment intensification rates were 15.9% and 26.0% (p < 0.0001) and the discontinuation rates were 38.3% and 40.0% (p = 0.14) for exenatide and glargine, respectively. Alternatively, 14.9% of exenatide-treated patients switched therapies, compared to 10.0% of glargine-treated patients (p < 0.0001). Overall, glargine-treated patients were more likely to modify their treatment [hazard ratio (HR) = 1.33, p < 0.0001] with shorter mean time on treatment until modification (123 vs. 159 days, p < 0.0001). Compared to exenatide-treated patients, glargine-treated patients were more likely to discontinue [hazard ratio (HR) = 1.25, p < 0.0001] or intensify therapy (HR = 1.72, p < 0.0001) but less likely to switch (HR = 0.71, p < 0.0001) the index therapy.

Conclusions: Patients treated for type 2 diabetes with exenatide BID or insulin glargine differ in their adherence to therapy. Exenatide-treated patients were less likely to discontinue or modify treatment but more likely to switch therapy compared to glargine-treated patients.

No MeSH data available.


Related in: MedlinePlus