Preferential prescribing and utilization trends of diabetes medications among patients with renal impairment: Emerging role of linagliptin and other dipeptidyl peptidase 4 inhibitors

Abstract

Summary: Objectives: Although many newer diabetes medications have become available in the last decade, most have not been widely studied in populations with chronic kidney disease under routine care. Linagliptin, a recently marketed dipeptidyl peptidase 4 (DPP‐4) inhibitor, is the only agent in the U.S. that does not require dose adjustment in patients with diabetes mellitus type 2 (T2DM) and renal impairment. We sought to describe baseline kidney function and other key characteristics among patients with diabetes mellitus type 2 (T2DM) initiating linagliptin and other diabetes medications, and to explore prescribing patterns among T2DM patients with moderate to severe renal impairment before and after the launch of linagliptin. Design: Using a population‐based cohort study design nested in a large U.S. commercial healthcare dataset linked to laboratory values, we described characteristics of T2DM patients initiating linagliptin and other diabetes medications between May 2011 (launch of linagliptin) and September 2015. We also explored prescribing trends among T2DM patients with moderate to severe renal impairment (ICD‐9 diagnosis code 585.3x‐6x) who initiated linagliptin and other diabetes medications between January 2006 to September 2015 (before and after the launch of linagliptin). Patients: We identified 1,174,476 T2DM patients initiating a diabetes medication (28,900 linagliptin initiators) between 05/2011‐09/2015. We also identified 100,847 T2DM patients with moderate to severe renal impairment initiating a diabetes agent between 01/2006‐09/2015. Results and Conclusion: Among patients initiating newer diabetes medications between 05/2011‐09/2015, those initiating linagliptin had the highest prevalence of moderate to severe renal impairment, suggesting preferential prescribing in routine care. DPP‐4 inhibitors overall were among the most frequently chosen agents among T2DM patients with moderate to severe renal impairment between 01/2006‐09/2015. Further investigation of the safety and effectiveness of DPP‐4 inhibitors in routine care of T2DM patients with renal impairment is needed to either corroborate or discourage current prescribing patterns.