Patterns of use of incretin-based therapies in Europe and USA
Leal, I., Sammon, C., Masclee, GMC., Corrao, G., De Berardis, G., Bezemer, I., Gil, M., Martin, E., McGrogan, A., Schmedt, N., Seeger, JD., Trifiro, G., Pecchioli, S., Varas-Lorenzo, C., Smits, MM., Rijnbeek, P., Sturkenboom, M., & Romio, S. (2015). Patterns of use of incretin-based therapies in Europe and USA. Pharmacoepidemiology and Drug Safety, 24(S1), 106. Article 188. https://doi.org/10.1002/pds.3838
Background: Incretin‐based therapies (IBTs), dipeptidyl peptidase–IV inhibitors (DPP‐4I) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) were introduced in the market in 2005–2006. Safety warnings, potential additional indications (e.g. obesity and pre‐diabetes) or local policies could influence the patterns of use.
Objectives: The aim was to analyse the use of IBT in databases (DBs) participating in the SAFEGUARD project.
Methods: Prevalence (number of prevalent users/1000 person years [py]) and incidence (number of new users/1000 py) of use of GLP‐1RA and DPP‐4I in the DBs participating in the SAFEGUARD project (BIFAP (SP), GePaRD (DE), Regional DBs of Puglia and Lombardy, Health Search (IT), IPCI, PHARMO (NL), CPRD (UK) and Medicare (US)) were estimated across available time periods. The main characteristics of subjects (%, mean, standard deviation (s.d.) for categorical and continuous variables) at the time of the first prescription for an incretin‐based agent were described. The study period ranged from 2005 to 2013 (DB specific).
Results: Sitagliptin (a DPP‐4I) is the most commonly used IBT (prevalence in European (EU) DBs 0.05–0.76 and 18.4 users/1000 py in Medicare; incidence 0.05–0.54 users/1000 py in EU and 15.4/1000 py in Medicare). The use of liraglutide (a GLP‐1RA) has steeply increased in all DBs. Sitagliptin and liraglutide use increased over the time in particular in the second half of 2010. The mean age of GLP‐1RA new users is 48–56 years (yr) in EU DBs and 72 yr in Medicare; DPP‐4I use starts at older ages (EU, 58–63 yr; Medicare, 75 yr). IBTs are frequently co‐prescribed with biguanides (50–70%). In Medicare, 25% used TZD concomitantly with DPP‐4I and 34% with GLP‐1RA. This co‐medication pattern was observed in less than 10% EU DB. Sulfonylureas and biguanides were the most commonly used antihyperglycemic agents before the start of IBT.
Conclusions: The use of incretin‐based therapies has increased since they have been launched into the market. Sitagliptin, exenatide and liraglutide are the most frequently used. Their use starts at young ages.