Comparison of persistence and adherence between fixed-dose combinations and two-pill combinations in Japanese patients with type 2 diabetes

Abstract

Objective: To compare treatment patterns, persistence and adherence between fixed-dose combinations (FDCs) and two-pill combinations (TPCs) of oral antidiabetic drug (OAD) classes in Japanese patients with type 2 diabetes mellitus (T2DM) using administrative claims databases (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV]).

Methods: This was a retrospective, longitudinal cohort analysis conducted between 2011 and 2015, in patients with T2DM receiving OADs as FDC or TPC. Outcomes included prescribing patterns, treatment persistence and adherence.

Results: Data from 3474 and 3066 patients receiving FDCs, and 4325 and 5192 patients receiving TPCs from the JMDC and MDV databases, respectively, was extracted. The most common OAD combination received by over half of all patients was dipeptidyl peptidase-4 inhibitor (DPP-4i) + thiazolidinediones (TZDs) (64.1% [JMDC] and 70.5% [MDV]). Overall, 12-month persistence rates were higher in patients receiving FDCs compared with TPCs (70.4 vs. 66.2% [JMDC], 75.6 vs. 55.7% [MDV]). In the JMDC population receiving FDCs or TPCs, persistence rates were highest with DPP-4i schedules (67.5–83.5%). Median time to discontinuation was significantly longer with biguanide + TZD, and DPP-4i + TZD FDC schedules (p < .05) than TPC; adherence rates were ≥80% across all antidiabetic drug classes in both database populations.

Conclusions: Persistence with and adherence to OADs in Japanese patients with T2DM were greater with FDCs than with TPCs, which may suggest increased patient satisfaction due to reduced treatment burden. Further studies are warranted to investigate the impact of adherence and persistence of FDCs of OADs on glycemic control.

Keywords:

• Adherence
• diabetes mellitus
• persistence
• fixed-dose
• two-pill

Transparency

Declaration of funding

Funding for this research was provided by Takeda Pharmaceutical Company Limited, Tokyo, Japan.

Author contributions: R.N., H.K., A.O., Y.O., F.G. and Y.S. are responsible for the work described in this paper. R.N., H.K., A.O., Y.O., F.G. and Y.S. were involved in the conception, design or planning of the study. Y.O. and F.G. were involved in the analysis of data. R.N., H.K., K.K., A.O. and Y.S. were involved in the interpretation of results. R.N., H.K., K.K., A.O. and Y.O. contributed substantially to drafting of the manuscript.

Declaration of financial/other relationships

H.K., K.K., A.O. and Y.S. have disclosed that they are employees of Takeda Pharmaceutical Co. Ltd. F.G. and Y.O. have disclosed that they are employees of Creativ-Ceutical KK. R.N. has disclosed that she/he has received speaker honoraria from Astellas Pharma Inc., Nippon Boehringer Ingelheim Co. Ltd, Eli Lilly Japan KK, Kissei Pharmaceutical Co. Ltd, Medtronic Japan Co. Ltd, MSD, Novartis Pharma KK, Novo Nordisk Pharma Ltd, Sanofi KK and Takeda Pharmaceutical Co. Ltd.; and contract research fees for collaborative research with the Japan Diabetes Foundation.

A CMRO peer reviewer on this paper discloses being a member of the Invokana Speakers Bureau for Janssen Pharmaceuticals. The other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We acknowledge Sabah Farooq of FireKite, an Ashfield company, part of UDG Healthcare plc, for writing support during the development of this manuscript, which was funded by Takeda Pharmaceutical Co. Ltd (Tokyo, Japan), and complied with Good Publication Practice 3 ethical guidelines (Battisti et al. Ann Intern Med 2015;163:461-4).

Data sharing: Given the administrative nature of the data, no informed consent was required for patient data; however, all data is fully anonymized.

Disclaimer: The study made use of de-identified data from the JMDC and MDV databases. The opinions, results and conclusions reported are those of the authors. No endorsement by JMDC or MDV or any of its funders or partners is intended or should be inferred.