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Evaluating time to treatment intensification among drug naïve type 2 diabetes patients: a comparison of initial
Zahra Majd1, Sai S Cheruvu1, Hua Chen1
1Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
Objective:
To evaluate the impact of the initial pharmacotherapy approach - initial combination therapy vs. traditional step-therapy - on time to treatment intensification (TI) among drug naïve type 2 diabetes (T2D) patients during 12 months of follow-up.
Methods:
Retrospective cohort study was conducted from 2017 to 2019, using the Merative MarketScan. We included drug naïve T2D patients ≥ 18 years old who received dual therapy, either as their initial treatment regimen or add-on treatment. TI was defined as either add-on of third noninsulin ADM or initiation of insulin. A multivariable Cox regression model was conducted to assess time to TI between the two study groups, adjusting for the baseline covariates.
Results:
Out of 23,253 patients, 8,103 were in step-therapy, and 15,150 were in the initial combination cohort. About 16% of patients received TI during the follow-up period. Average time to TI was 145 and 147 days for the step-therapy and initial combination cohort, respectively. Unadjusted survival analysis showed a worse survival rate for step-therapy compared to the initial combination group. The multivariable Cox model indicated that receiving step-therapy was associated with a significantly higher hazard for TI (HR = 1.20, 95% CI = 1.05-1.36).
Conclusions:
Patients who received step-therapy had higher risk and shorter time to TI during 12-month follow-up vs initial combination.
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