Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study.
Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study.
复制标题
DOI：
10.1038/s41591-022-02121-6
复制
发表时间：
2023-03
期刊：
影响因子：
82.9
通讯作者：
Hattersley AT
中科院分区：
文献类型：
--
作者：
Shields BM;Angwin CD;Shepherd MH;Britten N;Jones AG;Sattar N;Holman R;Pearson ER;Hattersley AT
患者偏好是慢性疾病（例如 2 型糖尿病）药物选择的关键，有许多不同的药物可供选择。患者偏好平衡潜在疗效和潜在副作用。由于药物反应的两个方面在个体之间可能存在显着差异，这一决定可以由患者亲自体验替代药物来告知，就像交叉试验中发生的那样。在 TriMaster（NCT02653209、ISRCTN12039221）中，随机双盲、三向交叉试验患者接受三种不同的二线或三线每日一次 2 型糖尿病降糖药物（吡格列酮 30mg、西他列汀 100mg 和卡格列净 100mg）。作为预先指定的次要终点的一部分，我们在患者尝试了所有 3 种药物后检查了患者的药物偏好。 448 名参与者接受了所有三种药物的治疗，总体上显示出相似的血糖控制（吡格列酮的 HbA1c 为 59.5，西格列汀为 59.9，卡格列净为 60.5mmol/mol，p=0.19）。 115 名患者（25%）首选吡格列酮，158 名患者（35%）首选西他列汀，175 名患者（38%）首选卡格列净。个体患者首选的药物与较低的 HbA1c（与非首选药物相比平均降低 4.6 [95%CI 3.9, 5.3]mmol/mol）和较少的副作用（与非首选药物相比平均减少 0.50[0.35, 0.64] 副作用）相关。根据个人首选药物分配治疗，而不是为所有患者分配总体上最首选的药物（卡格列净），将导致更多患者实现最低 HbA1c (70% vs 30%) 和最少的副作用 (67% vs 50%)。当精确方法无法预测个体的明确最佳治疗方法时，允许患者在选择长期治疗之前尝试潜在的合适药物可能是优化 2 型糖尿病治疗的实用替代方案。
Patient preference is key for medication selection in chronic medical conditions, like type 2 diabetes, where there are many different drugs available. Patient preference balances potential efficacy with potential side effects. As both aspects of drug response can vary markedly between individuals this decision could be informed by the patient personally experiencing the alternative medications, as occurs in a crossover trial. In the TriMaster (NCT02653209, ISRCTN12039221), randomised double-blind, three-way crossover trial patients received three different second or third line once-daily type 2 diabetes glucose-lowering drugs (pioglitazone 30mg, sitagliptin 100mg, and canagliflozin 100mg). As part of a prespecified secondary endpoint we examined patients’ drug preference after they had tried all 3 drugs. 448 participants were treated with all three drugs which overall showed similar glycaemic control (HbA1c on pioglitazone 59.5 sitagliptin 59.9, canagliflozin 60.5mmol/mol, p=0.19). 115 patients (25%) preferred pioglitazone, 158 (35%) sitagliptin, 175 (38%) canagliflozin. The drug preferred by individual patients was associated with a lower HbA1c (mean 4.6 [95%CI 3.9, 5.3]mmol/mol lower vs. non-preferred) and fewer side effects (mean 0.50[0.35, 0.64] fewer side effects vs. non-preferred). Allocating therapy based on individually preferred drugs, rather than allocating all patients the overall most preferred drug (canagliflozin), would result in more patients achieving the lowest HbA1c for them (70% v 30%) and the fewest side effects (67% v 50%). When precision approaches do not predict a clear optimal therapy for an individual, allowing patients to try potential suitable medications before they choose long term therapy could be a practical alternative to optimising treatment for type 2 diabetes.
登录
查看更多内容
影响因子：
2.3
作者：
Bogelund, Mette;Vilsboll, Tina;Lammert, Morten
通讯作者：
Lammert, Morten
影响因子：
3.1
作者：
Gentile, Sandro;Fusco, Alessandra;Strollo, Felice
通讯作者：
Strollo, Felice
影响因子：
8.2
作者：
Tsapas, A.;Matthews, D. R.
通讯作者：
Matthews, D. R.
影响因子：
16.2
作者：
Purnell, Tanjala S.;Joy, Susan;Maruthur, Nisa
通讯作者：
Maruthur, Nisa
影响因子：
3.5
作者：
Hauber, A. B.;Mohamed, A. F.;Falvey, H.
通讯作者：
Falvey, H.