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Cited by 67Diabetes Treatment and ManagementMedication Adherence and ComplianceDiabetes Management and Research

Discontinuation and reinitiation of SGLT-2 inhibitors and GLP-1R agonists in patients with type 2 diabetes: a nationwide study from 2013 to 2021

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Malik, Mariam Elmegaard, Falkentoft, Alexander Christian, Jensen, Jesper, Zahir, Deewa, Parveen, Saaima, Alhakak, Amna, Andersson, Charlotte, Petrie, Mark C. +4 more·2023·The Lancet Regional Health - Europe
DOI 10.1016/j.lanepe.2023.100617PMC PMC10230617
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Abstract

Background: Small observational studies have observed poor persistency to sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucacon-like-peptide-1-receptor agonists (GLP1-RA), contrary to what has been reported in clinical trials. Therefore, we investigated the risk of discontinuing SGLT2-is and GLP1-RAs in patients with type 2 diabetes (T2D) in a nationwide population. Methods: From Danish nationwide registers, all first-time users of SGLT2-is and GLP1-RAs from 2013 to 2021 were identified. Adherence over the first year of therapy, the five-year risk of discontinuing therapy for the first time and the subsequent one-year probability of reinitiating therapy, was assessed. The Aalen-Johansen estimator was used to account for censoring and competing risks and multivariable Cox regression models were used to identify covariates associated with discontinuation. Findings: A total of 77,745 first-time users of SGLT2-is (64% male, median age 64 [interquartile range 56-72]) and 56,037 first-time users of GLP1-RAs (56% male, median age 61 [53-70]) were included. The absolute five-year risk of discontinuing therapy was 56% (95% CI: 55-57) and 45% (45-46) for SGLT2-i- and GLP1-RA users, respectively, with a significantly decreased risk over the period studied. The subsequent one-year probability of reinitiating therapy was 24% (95% CI: 24-25) for initial SGLT2-i users and 26% (25-27) for GLP1-RA users. Interpretation: Approximately half of the users of SGLT2-is and GLP1-RAs discontinued therapy within five years, respectively. However, a large proportion of these patients reinitiated therapy during the following year. Further insight into the reasons for discontinuation and initiatives to reduce the time to reinitiation in eligible patients are warranted. Funding: The work was funded by an unrestricted research grant from 'Department of Cardiology, Herlev and Gentofte University Hospital'.

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Authors
Malik, M. E., Falkentoft, A. C., Jensen, J., Zahir, D., Parveen, S., Alhakak, A., Andersson, C., Petrie, M. C., Sattar, N., McMurray, J. J. V., Køber, L., & Schou, M.
Affiliations
  • Copenhagen University Hospital (DK)
  • University of Copenhagen (DK)
  • Brigham and Women's Hospital (US)
  • University of Glasgow (GB)
Corresponding author
Malik, Mariam Elmegaard
ORCID
Venue
The Lancet Regional Health - Europe
Publisher
Elsevier BV
Published
2023-06
Volume
29
Pages
100617
ISSN
2666-7762 (ISSN-L)
DOI
10.1016/j.lanepe.2023.100617
PMC
PMC10230617
OpenAlex
W4327719375
Cited by
67
References
9
Citations by year
2026: 19 · 2025: 26 · 2024: 17 · 2023: 5
FWCI
13.74
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Regional Health - Europe (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
Funders
Gentofte University Hospital
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
SGLT2 inhibitors, GLP-1 receptor agonists, type 2 diabetes, drug discontinuation, treatment persistence, antidiabetic drug utilization, first-time users

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