Prescribing Patterns of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Patients With T2DM and ASCVD in South Korea.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2025-07-01 DOI:10.1002/pds.70183

Yeong Rok Eom, Hajung Joo, Seung Eun Chae, Nam Kyung Je

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引用次数: 0

Abstract

Background: Despite the cardiovascular benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), their utilization remains low globally. This study aimed to evaluate the utilization of SGLT2i and GLP1RA in patients with T2DM and ASCVD, as well as the factors associated with their use in South Korea.

Methods: We conducted a retrospective study using the National Patient Sample claims data from 2015 to 2020. Adults aged 20 years or older with confirmed diagnoses of both T2DM and ASCVD between March 1 and October 31 of each year were included. The utilization of SGLT2i and GLP1RA was assessed based on prescriptions filled within 60 days of the index date. Multivariable logistic regression was used to identify factors associated with their use. Annual trends in utilization were evaluated using the Cochran-Armitage trend test.

Results: In our study of 57 576 study population, the use of SGLT2i increased from 1.20% in 2015 to 10.51% by 2020. GLP1RA usage increased from 0% to 1.17% over the same period. Older age, chronic kidney disease (OR 0.52, 95% CI 0.41-0.66), and concurrent use of dipeptidyl peptidase 4 inhibitors (DPP4i) (OR 0.09, 95% CI 0.09-0.10) significantly reduced the likelihood of SGLT2i use. In contrast, factors such as comorbid dyslipidemia (OR 1.41, 95% CI 1.25-1.60), heart failure (OR 1.22, 95% CI 1.09-1.37), concurrent use of sulfonylurea (SU) (OR 1.30, 95% CI 1.20-1.40), and prescriptions from cardiologists (OR 1.22, 95% CI 1.07-1.40) were positively associated with higher SGLT2i usage. For GLP1RA, negative influences included older age, concurrent DPP4i use (OR 0.12, 95% CI 0.08-0.16), and non-endocrinologist prescription, whereas female sex (OR 1.35, 95% CI 1.06-1.73), dyslipidemia (OR 1.68, 95% CI 1.10-2.66), and the use of insulin (OR 3.71, 95% CI 2.83-4.85), or SU (OR 3.13, 95% CI 2.44-4.02) use were positive factors.

Conclusions: Despite the known cardiovascular benefits and increasing utilization trends of SGLT2i and GLP1RA, our findings reveal that 88.35% of eligible patients with T2DM and ASCVD remained untreated with these agents as of 2020. This study suggests disparities in the use of these agents based on patients' characteristics and physician specialties. Further efforts to explore and address potential barriers to the use of these agents could enhance their clinical benefits by improving access for high-risk patients.

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韩国T2DM和ASCVD患者中SGLT2抑制剂和GLP-1受体激动剂的处方模式

背景：尽管钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）和胰高血糖素样肽-1受体激动剂（GLP1RA）在2型糖尿病（T2DM）和动脉粥样硬化性心血管疾病（ASCVD）患者中具有心血管益处，但它们在全球的使用率仍然很低。本研究旨在评估SGLT2i和GLP1RA在韩国T2DM和ASCVD患者中的使用情况，以及与它们的使用相关的因素。方法：利用2015年至2020年的全国患者样本索赔数据进行回顾性研究。每年3月1日至10月31日期间确诊为2型糖尿病和ASCVD的年龄在20岁或以上的成年人被纳入研究。SGLT2i和GLP1RA的使用情况以指标日期后60天内的处方填写情况为基础进行评估。使用多变量逻辑回归来确定与使用相关的因素。利用Cochran-Armitage趋势检验评估年度利用率趋势。结果：在我们对55776名研究人群的研究中，SGLT2i的使用率从2015年的1.20%上升到2020年的10.51%。同期，GLP1RA的使用率从0%增加到1.17%。年龄较大、慢性肾脏疾病（OR 0.52, 95% CI 0.41-0.66）和同时使用二肽基肽酶4抑制剂（DPP4i）（OR 0.09, 95% CI 0.09-0.10）显著降低了SGLT2i使用的可能性。相比之下，合并症血脂异常（OR 1.41, 95% CI 1.25-1.60）、心力衰竭（OR 1.22, 95% CI 1.09-1.37）、同时使用磺脲类药物（OR 1.30, 95% CI 1.20-1.40）和心脏病专家处方（OR 1.22, 95% CI 1.07-1.40）等因素与SGLT2i的使用呈正相关。对于GLP1RA，负面影响包括年龄较大、同时使用DPP4i （OR 0.12, 95% CI 0.08-0.16）和非内分泌医生处方，而女性（OR 1.35, 95% CI 1.06-1.73）、血脂异常（OR 1.68, 95% CI 1.10-2.66）和使用胰岛素（OR 3.71, 95% CI 2.83-4.85）或SU （OR 3.13, 95% CI 2.44-4.02）是积极因素。结论：尽管已知SGLT2i和GLP1RA的心血管益处和使用趋势日益增加，但我们的研究结果显示，截至2020年，88.35%的符合条件的T2DM和ASCVD患者仍未接受这些药物治疗。这项研究表明，根据患者的特点和医生的专业，这些药物的使用存在差异。进一步努力探索和解决使用这些药物的潜在障碍，可以通过改善高危患者的可及性来提高其临床效益。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.