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Open AccessArticle

Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data

1
Servicio Aragonés de Salud (SALUD), 50009 Zaragoza, Spain
2
EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 50009 Zaragoza, Spain
3
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), ISCIII, 28222 Madrid, Spain
4
Grupo de Trabajo de Utilización de Fármacos de la SemFYC, 50009 Zaragoza, Spain
5
Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), IIS Aragón, 50009 Zaragoza, Spain
7
Centro de Investigación Biomédica del Gobierno de Navarra (Navarrabiomed), Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), 31008 Pamplona, Spain
8
CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, 80131 Napoli NA, Italy
9
Department of Pharmacy, University of Naples Federico II, 80131 Napoli NA, Italy
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work and served as first co-authors.
These authors contributed equally to this work and served as senior co-authors.
Int. J. Environ. Res. Public Health 2020, 17(10), 3742; https://doi.org/10.3390/ijerph17103742
Received: 28 April 2020 / Revised: 18 May 2020 / Accepted: 20 May 2020 / Published: 25 May 2020
The World Health Organization considers the non-adherence to medication a significant issue with global impact, especially in chronic conditions such as type 2 diabetes. We aim to study antidiabetic treatment initiation, add-on, treatment switching, and medication persistence. We conducted an observational study on 4247 individuals initiating antidiabetic treatment between 2013 and 2014 in the EpiChron Cohort (Spain). We used Cox regression models to estimate the likelihood of non-persistence after a one-year follow-up, expressed as hazard ratios (HRs). Metformin was the most frequently used first-line antidiabetic (80% of cases); combination treatment was the second most common treatment in adults aged 40–79 years, while dipeptidyl peptidase-4 inhibitors were the second most common in individuals in their 80s and over, and in patients with renal disease. Individuals initiated on metformin were less likely to present addition and switching events compared with any other antidiabetic. Almost 70% of individuals initiated on monotherapy were persistent. Subjects aged 40 and over (HR 0.53–0.63), living in rural (HR 0.79) or more deprived areas (HR 0.77–0.82), or receiving polypharmacy (HR 0.84), were less likely to show discontinuation. Our findings could help identify the population at risk of discontinuation, and offer them closer monitoring for proper integrated management to improve prognosis and health outcomes. View Full-Text
Keywords: adherence; antidiabetics; comorbidity; diabetes; persistence; real-world data; Spain; treatment patterns adherence; antidiabetics; comorbidity; diabetes; persistence; real-world data; Spain; treatment patterns
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Moreno-Juste, A.; Poblador-Plou, B.; Aza-Pascual-Salcedo, M.; González-Rubio, F.; Malo, S.; Librero López, J.; Pico-Soler, V.; Giménez Labrador, E.; Mucherino, S.; Orlando, V.; Menditto, E.; Prados-Torres, A.; Gimeno-Miguel, A. Initial Therapy, Regimen Change, and Persistence in a Spanish Cohort of Newly Treated Type 2 Diabetes Patients: A Retrospective, Observational Study Using Real-World Data. Int. J. Environ. Res. Public Health 2020, 17, 3742.

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