Characteristics of patients prescribed sitagliptin and other oral antihyperglycaemic agents in a large US claims database
Characteristics of patients prescribed sitagliptin and other oral antihyperglycaemic agents in a large US claims database
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DOI：
10.1111/j.1742-1241.2010.02516.x
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发表时间：
2010-11-01
影响因子：
2.6
通讯作者：
Girman, C. J.
中科院分区：
文献类型：
--
作者：
Cai, B.;Katz, L.;Girman, C. J.
背景和目的：由于不同治疗方案患者的基线人口统计学、病史和健康状况的差异，药物的非随机比较研究可能存在偏倚。2型糖尿病（T2 DM）患者服用西格列汀的特点进行了比较，患者服用其他口服抗高血压药物（OAHA）在一个大型的美国保险索赔database.Materials和方法：使用联合医疗数据库，我们确定了T2 DM患者至少有一个OAHA处方，至少1年前登记。患者被分为亚组，包括西格列汀或其他OAHA、单药治疗的辅助治疗和三联或三联以上治疗。研究窗口期内首次OAHA处方前12个月的合并症基于ICD-9诊断代码和NDC处方代码。结果：在大多数合并症中，西格列汀处方患者的合并症患病率始终较高（30种评估的合并症中有20种p < 0.05）。总体而言，基线差异是明显的（p < 0.0001）视网膜病变（5.7% vs. 3.4%），肾衰竭（5.1% vs. 2.6%），蛋白尿（2.8%比2.0%），高血压（76.9% vs. 68.2%），充血性心力衰竭（3.4%对2.6%）、心肌梗死（18.0%对14.4%）和慢性神经系统疾病（8.1%对6.6%）。初始单药治疗亚队列的差异最明显。较高比例的西格列汀使用者有心血管药物处方（84.2% vs. 74.9%）。结论：西格列汀使用者有较高比例的合并症，更多地使用处方药和医生就诊。研究人员应该意识到，西格列汀是开给健康状况似乎更差的患者的。分析观察性、非随机研究的能力可能受到不同治疗之间患者特征的显著差异的限制。
P>Background and aims:Non-randomised comparative studies of pharmacological agents can be biased because of differences in baseline demographics, medical history and health status of patients prescribed different therapies. Characteristics of patients with type 2 diabetes mellitus (T2DM) taking sitagliptin were compared with patients taking other oral antihyperglycaemic agents (OAHA) in a large US insurance claims database.Materials and methods:Using the United Health Care database, we identified T2DM patients with at least one OAHA prescription, and at least 1 year prior enrolment. Patients were classified into subcohorts including sitagliptin or other OAHA, add-on to monotherapy, and triple or more therapy. Comorbidities 12 months before the first OAHA prescription in study window were based on ICD-9 diagnostic codes and NDC codes for prescriptions.Results:Prevalence of comorbidities was consistently higher for patients with sitagliptin prescriptions across most comorbidities (p < 0.05 for 20 of 30 assessed comorbidities). Overall, baseline differences were apparent (p < 0.0001) for retinopathy (5.7% vs. 3.4%), renal failure (5.1% vs. 2.6%), proteinuria (2.8% vs. 2.0%), hypertension (76.9% vs. 68.2%), congestive heart failure (3.4% vs. 2.6%), myocardial infarction (18.0% vs. 14.4%) and chronic neurological conditions (8.1% vs. 6.6%). Differences were most pronounced for initial monotherapy subcohorts. A higher proportion of sitagliptin users had prescriptions for cardiovascular medication (84.2% vs. 74.9%).Conclusion:Sitagliptin users had higher proportions of comorbidities and greater use of prescription medications and physician visits. Researchers should be aware that sitagliptin is prescribed to patients with seemingly worse health status. Ability to analyse observational, non-randomised studies may be limited by substantial differences in patient characteristics between different treatments.