Compliance with the DPP-4 inhibitors dose adjustment recommendations based on renal function in a population database

Area of Science:

• Pharmacology and Clinical Pharmacy
• Nephrology
• Endocrinology

Background:

• Dipeptidyl peptidase-4 inhibitors (DPP4is) are commonly prescribed for type 2 diabetes mellitus (T2DM).
• Renal impairment necessitates dose adjustments for many DPP4is.
• Real-world prescription patterns regarding renal function are not well-documented.

Purpose of the Study:

• To investigate the prescription patterns of DPP4is based on estimated glomerular filtration rate (eGFR).
• To assess the extent of DPP4i overtreatment in T2DM patients with varying degrees of renal function under real-world conditions.

Main Methods:

• A descriptive, observational study utilizing the SIDIAP Catalonia population database.
• Inclusion of T2DM patients with assessed kidney function on active DPP4i treatment.
• Calculation of prescribed daily dose (PDD) versus theoretical adjusted dose (DDD-adj) and the PDD/DDD-adj ratio to identify overtreatment (ratio > 1.2).

Main Results:

• The study included 72,135 T2DM patients (mean age 69.7 years, 55.9% male).
• Overall, 7.15% of DPP4i treatments involved overdosage.
• In advanced renal stages (IIIb-V), overtreatment significantly increased to 36.8% (58.7% excluding linagliptin).

Conclusions:

• A substantial proportion of T2DM patients with advanced renal failure receive overdosed DPP4is in clinical practice.
• Prescription doses of DPP4is are frequently not adequately adjusted to the patient's eGFR.
• This highlights a need for improved adherence to dosing guidelines for DPP4is in patients with impaired kidney function.