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- Title
Patterns and trends of utilization of incretin-based medicines between 2008 and 2014 in three Italian geographic areas.
- Authors
Roberto, Giuseppe; Bartolini, Claudia; Francesconi, Paolo; Gini, Rosa; Barone-Adesi, Francesco; Giorgianni, Francesco; Pizzimenti, Valeria; Trifirò, Gianluca; Ferrajolo, Carmen; Tari, Michele; Da Cas, Roberto; Maggini, Marina; Spila-Alegiani, Stefania; Poluzzi, Elisabetta; Baccetti, Fabio
- Abstract
Background: The incretin-based medicines GLP1 analogues (GLP1a) and dipeptidyl peptidase-4 inhibitors (DPP4i) are hypoglycaemic agents licensed for the treatment of type 2 diabetes mellitus (T2DM). Although these drugs possess comparable efficacy and low risk of hypoglycaemia, differences in terms of route of administration (subcutaneous versus oral), effect on body weight and gastrointestinal tolerabily can impact their actual use in clinical practice. This study aimed to describe the real-world utilization of incretin-based medicines in the Italian clinical practice. Methods: A multi-database, population-based, descriptive, cohort study was performed using administrative data collected between 2008 and 2014 from three Italian geographic areas. Subjects aged ≥18 were selected. New users were defined as those with ≥1 dispensing of GLP1a or DPP4i during the year of interest and none in the past. Trends of cumulative annual incidence of use in the general adult population were observed. New users of GLP1a or DPP4i were respectively described in terms of demographic characteristics and use of antidiabetic drugs during 1 year before and after the first incretin dispensing. Results: The overall study population included 4,943,952 subjects. A total of 7357 new users of GLP1a and 41,907 of DPP4i were identified during the study period. Incidence of use increased between 2008 (0.2‰ for both GLP1a and DPP4i) and 2011 (GLP1a = 0.6‰; DPP4i = 2.5‰) and slightly decreased thereafter. In 2014, 61% of new GLP1a users received once-daily liraglutide while 52% of new DPP4i users received metformin/DPP4i in fixed-dose. The percentage of new DPP4i users older than 65 years of age increased from 30.9 to 62.6% during the study period. Around 12% of new users had not received any antidiabetic before starting an incretin. Conclusions: During the study period, DPP4i rapidly became the most prescribed incretin-based medicine, particularly among older new user. The choice of the specific incretin-based medicine at first prescription appeared to be directed towards those with higher convenience of use (e.g. oral DPP4i rather than subcutaneous GLP1a, once-daily liraglutide rather than twice-daily exenatide). The non-negligibile use of incretin-based medicines as first-line pharmacotherapy for T2DM warrants further effectiveness and safety evaluations to better define their place in therapy.
- Subjects
ITALY; THERAPEUTIC use of protease inhibitors; HYPOGLYCEMIC agents; INCRETINS; EXENATIDE; AGE distribution; DRUG utilization; LONGITUDINAL method; RESEARCH methodology; MEDICAL prescriptions; TYPE 2 diabetes; POPULATION geography; PHYSICIAN practice patterns; DISEASE incidence; METFORMIN; GLUCAGON-like peptide-1 agonists; THERAPEUTICS
- Publication
BMC Endocrine Disorders, 2019, Vol 19, Issue 1, pN.PAG
- ISSN
1472-6823
- Publication type
Article
- DOI
10.1186/s12902-019-0334-y