title: Comparative persistence and adherence with newer anti-hyperglycemic agents to treat patients with type 2 diabetes in the United States.
abstract: OBJECTIVE
  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 5 mg (40%), dapagliflozin 10 mg (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 300 mg (64%) vs canagliflozin 100 mg. Median adherence rates for canagliflozin 100 mg (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.
authors.affiliation: a Janssen Scientific Affairs, LLC , Raritan , NJ , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cai
authors.affiliation: b STATinMED Research , Ann Arbor , MI , USA.
authors.forename: Yuexi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: b STATinMED Research , Ann Arbor , MI , USA.|c Center for Innovation & Outcomes Research, Columbia University , New York , NY , USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.affiliation: b STATinMED Research , Ann Arbor , MI , USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.affiliation: a Janssen Scientific Affairs, LLC , Raritan , NJ , USA.
authors.forename: Wing
authors.initials: W
authors.lastname: Chow
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D016527:Drug Costs; D000077270:Exenatide; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics*; D000069450:Liraglutide; D008297:Male; D055118:Medication Adherence; D010455:Peptides / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D014688:Venoms / Q000191:economics*
chemical_list: D007004:Hypoglycemic Agents; D010455:Peptides; D014688:Venoms; D000069450:Liraglutide; D000077270:Exenatide
keywords: Adherence; Anti-hyperglycemic; DPP-4; Diabetes; GLP-1; Persistence; SGLT2