Predictors of persistence of use of the novel antidiabetic agent acarbose

Background: Acarbose is the first of a new class of antidiabetic agents, the ol-glucosidase inhibitors. This study characterizes and identifies predictors of persistence of use of acarbose. Methods: Medical, pharmaceutical, and demographic records were extracted for 2 cohorts of patients (social assistance recipients and seniors) from the databases of Quebec's provincial health plan. Patients were eligible for inclusion if they had received their first dispensation of acarbose between August 1, 1996, and December 31, 1997. The observation period included at least 1 year before the first dispensation and a minimum of 4 months after. Results: New users of acarbose included 216 social assistance recipients and 677 seniors who were followed up for 82914 and 270041 person-days, respectively. Median persistence with acarbose treatment was 83 days (95% confidence interval, 75-105 days) for social assistance recipients and 105 days (95% confidence interval, 90-119 days) for seniors. In both cohorts, treatment by an endocrinologist vs another physician predicted longer treatment persistence. In the seniors cohort, additional determinants of (earlier) treatment discontinuation included a higher initial daily dose, previous treatment with insulin, and consultation with a gastroenterologist after treatment initiation. Conclusion: New users of acarbose showed low persistence in 2 cohorts of beneficiaries of Quebec's provincial health plan. Prescribing specialist was an important predictor of persistence in seniors and the socially assisted. The importance of 4 additional factors in seniors only led to hypotheses concerning population differences in treatment expectations and in the occurrence and tolerance of adverse effects.