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

Area of Science:

• Pharmacology
• Nephrology
• Endocrinology

Background:

• Dipeptidyl peptidase-4 inhibitors (DPP4is) are commonly prescribed for type 2 diabetes mellitus (T2DM).
• Renal function significantly impacts the appropriate dosing of many medications, including DPP4is.
• Inadequate dose adjustment of DPP4is in patients with reduced kidney function can lead to adverse events.

Purpose of the Study:

• To investigate the real-world prescription patterns of different DPP4 inhibitors based on estimated glomerular filtration rate (eGFR).
• To identify the prevalence of inappropriate DPP4 inhibitor dosing in T2DM patients with varying degrees of renal impairment.

Main Methods:

• A descriptive, observational study utilizing the SIDIAP Catalonia population database.
• Inclusion criteria: T2DM diagnosis, assessed kidney function (eGFR CKD-epi), and active DPP4i treatment.
• Analysis included prescribed daily dose (PDD), theoretically adjusted daily dose (DDD-adj), and PDD/DDD-adj ratio to identify overdosage (>1.2).

Main Results:

• The study included 72,135 T2DM patients (mean age 69.7 years, 55.9% male).
• Overall overdosage of DPP4is was observed in 7.15% of treatments.
• In advanced renal stages (IIIb, IV, V), overdosage increased significantly to 36.8% (58.7% excluding linagliptin).

Conclusions:

• Real-world clinical practice shows significant overdosage of DPP4is in T2DM patients with advanced renal failure.
• Doses are frequently not adjusted appropriately to the patient's glomerular filtration rate.
• This highlights a critical need for improved prescribing practices and patient monitoring to ensure safe and effective DPP4i use in renal impairment.