Comparative persistence and adherence with newer anti-hyperglycemic agents to treat patients with type 2 diabetes in the United States

Objectives: Non-adherence and non-persistence to anti-hyperglycemic agents are associated with worse clinical and economic outcomes in patients with type 2 diabetes. This study evaluated treatment persistence and adherence across newer anti-hyperglycemic agents (canagliflozin, dapagliflozin, sitagliptin, saxagliptin, linagliptin, liraglutide, or exenatide). Methods: This retrospective cohort study of Truven Health Analytics Marketscan databases included adult patients with type 2 diabetes whose first pharmacy claim for a newer anti-hyperglycemic agent was between February 1, 2014 and July 31, 2014. Treatment persistence and adherence were assessed for 12 months after the first claim (post-index). Persistence was defined as no gap 90 days between the end of one pharmacy claim and the start of the next pharmacy claim post-index. Adherence used two definitions: proportion of days covered (PDC) and medication possession ratio (MPR). Multivariable analyses of non-persistence (hazard ratios) and adherence (odds ratios) were adjusted for baseline demographics, drug cost, clinical characteristics, and other anti-hyperglycemic agents. Results: A total of 11,961 patients met all study selection criteria. Persistence rates at 12 months were significantly greater (p<0.05 for each comparison) for canagliflozin 100 mg (61%) compared with dapagliflozin 5mg (40%), dapagliflozin 10mg (41%), sitagliptin (48%), saxagliptin (42%), linagliptin (52%), liraglutide (47%), exenatide (23%), and long-acting exenatide (39%). The persistence rate was greater (p<0.05) for canagliflozin 300mg (64%) vs canagliflozin 100 mg. Median adherence rates for canagliflozin 100mg (MPR=0.83; PDC=0.79) and canagliflozin 300 mg (MPR=0.92; PDC=0.81) were greater than for the other index anti-hyperglycemic agents (MPR=0.33-0.75; PDC=0.33-0.72). Consistent results for treatment persistence and adherence were observed in multivariable analyses that were adjusted baseline characteristics. Conclusions: Canagliflozin was associated with better treatment persistence and treatment adherence compared with other anti-hyperglycemic agents in real-world settings.