TY - JOUR
T1 - Persistence on Novel Cardioprotective Antihyperglycemic Therapies in the United States
AU - Nargesi, Arash A.
AU - Clark, Callahan
AU - Aminorroaya, Arya
AU - Chen, Lian
AU - Liu, Mengni
AU - Reddy, Abraham
AU - Amodeo, Samuel
AU - Oikonomou, Evangelos K.
AU - Suchard, Marc A.
AU - McGuire, Darren K.
AU - Lin, Zhenqiu
AU - Inzucchi, Silvio
AU - Khera, Rohan
N1 - Funding Information:
Funding: The study was funded by Research & Development at UnitedHealth Group (Minnetonka, Minnesota) and the study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (Bethesda, Maryland) under award 1K23HL153775 to Dr. Khera.
Funding Information:
Drs. Clark, Reddy, and Amodeo are full-time employees of the UnitedHealth Group and own stock in the company. These authors played an active role in all aspects of the development of the study, including the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Suchard reports grants from the National Science Foundation and the National Institutes of Health during the conduct of the study and grants from Janssen Research and Development outside the submitted work. Dr. McGuire reports personal fees from Boehringer Ingelheim, Sanofi United States, Merck & Co., Merck Sharp and Dohme Corp., Eli Lilly and Company, NovoNordisk, AstraZeneca, Lexicon Pharmaceuticals, EISAI, Pfizer, Metavant, Applied Therapeutics, Afimmune, Bayer, CSL Behring, and Esperion. Zhenqiu Lin works under contract with the Centers for Medicare & Medicaid Services to develop quality measures. Dr. Inzucchi has received honoraria or consultancy fees from AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Lexicon, Merck, vTv Therapeutics, Esperion, and Abbott. Drs. Oikonomou and Khera are coinventors of US Provisional Patent Application number 63/177,117, Methods for neighborhood phenomapping for clinical trials, and are cofounders of Evidence2Health, a precision health and digital health analytics platform. The remaining authors have no conflicts of interest to declare.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Selected glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have cardioprotective effects in patients with type 2 diabetes mellitus (T2D) and elevated cardiovascular risk. Prescription and consistent use of these medications are essential to realizing their benefits. In a nationwide deidentified United States administrative claims database of adults with T2D, the prescription practices of GLP-1RAs and SGLT-2i were evaluated across guideline-directed co-morbidity indications from 2018 to 2020. The monthly fill rates were assessed for 12 months after the initiation of therapy by calculating the proportion of days with consistent medication use. Of 587,657 subjects with T2D, 80,196 (13.6%) were prescribed GLP-1RAs and 68,149 (11.5%) SGLT-2i from 2018 to 2020, representing 12.9% and 11.6% of patients with indications for each medication, respectively. In new initiators, 1-year fill rate was 52.5% for GLP-1RAs and 52.9% for SGLT-2i, which was higher for patients with commercial insurance than those with Medicare Advantage plans for both GLP-1RAs (59.3% vs 51.0%, p <0.001) and SGLT-2i (63.4% vs 50.3%, p <0.001). After adjusting for co-morbidities, there were higher rates of prescription fills for patients with commercial insurance (odds ratio 1.17, 95% confidence interval 1.06 to 1.29 for GLP-1RAs, and 1.59 [1.42 to 1.77] for SGLT-2i); and higher income (odds ratio 1.09 [1.06 to 1.12] for GLP-1RAs, and 1.06 [1.03 to 1.1] for SGLT-2i). From 2018 to 2020, the use of GLP-1RAs and SGLT-2i remained limited to fewer than 1 in 8 patients with T2D and indications, with 1-year fill rates around 50%. The low and inconsistent use of these medications compromises their longitudinal health outcome benefits in a period of expanding indications for their use.
AB - Selected glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have cardioprotective effects in patients with type 2 diabetes mellitus (T2D) and elevated cardiovascular risk. Prescription and consistent use of these medications are essential to realizing their benefits. In a nationwide deidentified United States administrative claims database of adults with T2D, the prescription practices of GLP-1RAs and SGLT-2i were evaluated across guideline-directed co-morbidity indications from 2018 to 2020. The monthly fill rates were assessed for 12 months after the initiation of therapy by calculating the proportion of days with consistent medication use. Of 587,657 subjects with T2D, 80,196 (13.6%) were prescribed GLP-1RAs and 68,149 (11.5%) SGLT-2i from 2018 to 2020, representing 12.9% and 11.6% of patients with indications for each medication, respectively. In new initiators, 1-year fill rate was 52.5% for GLP-1RAs and 52.9% for SGLT-2i, which was higher for patients with commercial insurance than those with Medicare Advantage plans for both GLP-1RAs (59.3% vs 51.0%, p <0.001) and SGLT-2i (63.4% vs 50.3%, p <0.001). After adjusting for co-morbidities, there were higher rates of prescription fills for patients with commercial insurance (odds ratio 1.17, 95% confidence interval 1.06 to 1.29 for GLP-1RAs, and 1.59 [1.42 to 1.77] for SGLT-2i); and higher income (odds ratio 1.09 [1.06 to 1.12] for GLP-1RAs, and 1.06 [1.03 to 1.1] for SGLT-2i). From 2018 to 2020, the use of GLP-1RAs and SGLT-2i remained limited to fewer than 1 in 8 patients with T2D and indications, with 1-year fill rates around 50%. The low and inconsistent use of these medications compromises their longitudinal health outcome benefits in a period of expanding indications for their use.
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U2 - 10.1016/j.amjcard.2023.03.002
DO - 10.1016/j.amjcard.2023.03.002
M3 - Article
C2 - 37012183
AN - SCOPUS:85151479478
SN - 0002-9149
VL - 196
SP - 89
EP - 98
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -