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Diabetes Obes Metab:口服降糖药作为固定剂量组合的长期临床疗效

2022-06-23 网络 网络

未能控制2型糖尿病会恶化生活质量并从长远来看损害相关器官,导致较高的发病率和死亡率。

背景:2型糖尿病的患病率以惊人的速度增长,仍然是一个全球健康问题。未能控制2型糖尿病会恶化生活质量并从长远来看损害相关器官,导致较高的发病率和死亡率。由于糖尿病带来的疾病负担越来越大,许多制药公司已经开发出用于代谢性疾病的单剂量联合疗法,因为它们比两片联合疗法的价格更低,并提高了药物的依从性。然而,只有几项研究调查了FDC联合抗糖尿病药物治疗的长期临床结果。

先前的证据表明,从患者和医生的角度来看,在治疗过程中早期使用FDC可能有更多的优势。改善对口服抗糖尿病药物(OAD)和/或其他并发症药物的依从性是预防或治疗与糖尿病相关的长期并发症并将经济负担降至最低的关键。先前的一项研究报告了依从性和医疗费用之间的强烈关联,其中依从性增加10%与糖化血红蛋白A1c水平降低0.1%相关。此外,依从性差与血糖控制差以及随后增加的发病率、死亡率和医疗费用有关。为了减轻2型糖尿病治疗的复杂性,FDC可能会通过简化2型糖尿病患者的治疗方案来提高用药依从性,从而加强血糖控制。

目的:临床上有必要利用真实世界的数据,通过比较依从性和持久性的治疗模式和临床结果与TPC,更好地阐明FDDC在2型糖尿病患者常规护理中的作用。

目的:2型糖尿病患者通常需要一种以上的药物来控制血糖。尽管单药㼿联合用药可能改善依从性,但其对临床结果的影响尚不清楚。我们使用真实世界的数据比较了FDC和两丸联合(TPC)疗法的治疗模式和临床结果。

方法:我们利用韩国医疗保健数据库(2002-2015)进行了一项全国性的回顾性队列研究。我们发现了两组2型糖尿病患者,他们在首次服用二甲双胍或磺脲类药物后4个月内开始接受㼿或TPC治疗。我们检查了急性心肌梗死、心力衰竭或中风患者死亡或住院的复合终点的持久性和依从性模式以及临床结果,并使用COX模型比较了治疗模式和临床结果的差异。

结果:在分别启动FDC和TPC治疗的5,143名和10,974名患者中,我们在倾向评分匹配后确定了5,143对㼿患者。FDC组的中位停止治疗时间(163d比146d)和覆盖天数比例(PDC)在12个月(平均0.60vs0.57,P<0.0001)和24月(0.53vs0.51vs0.51,P=0.014)明显高于TPC组。与TPC组相比,FDC组降低了综合临床结局(风险比为0.74,95%㼿可信区间为0.57~0.95)和卒中住院风险(0.68,0.49~0.94)。

表1在倾向评分匹配的队列中,12个月和24个月持续治疗的停止时间。

表2在匹配的队列中,使用TPC和FDC的患者在12个月和24个月时通过PDC评估治疗依从性。

表3接受TPC或FDC抗糖尿病药物治疗的患者的临床结果。

结论:FDC治疗可提供良好的心血管益处,特别是降低卒中住院风险,并对2型糖尿病患者有较好的用药依从性。

原文出处:  Cho SJ,  Oh IS,  Jeong HE, et al.Long-Term Clinical Outcomes of Oral Antidiabetic Drugs as Fixed-Dose Combinations: A Nationwide Retrospective Cohort Study.Diabetes Obes Metab 2022 Jun 07

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    2022-09-14 一闲
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    2023-02-08 docwu2019
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    2023-05-06 guojianrong
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