Persistence of fixed-dose combinations including dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes in Japan: analysis using a claims database

Persistence with treatments for type 2 diabetes (T2D) is fundamental but may be suboptimal. Fixed-dose combination (FDC) treatment can help improve persistence with treatment, although current data are limited. This study described treatment patterns associated with commonly used FDC treatments based on dipeptidyl peptidase-4 inhibitors (DPP-4is) in Japan. This noninterventional study evaluated data from a large hospital-based claims database in Japan between 2017 and 2023. Participants with T2D were receiving DPP-4i-based FDC treatments: DPP-4i/sodium-glucose cotransporter-2 inhibitor (SGLT2i), DPP-4i/metformin (met), DPP-4i/thiazolidinedione (TZD). In total, 255,974 patients were prescribed DPP-4i FDC, mostly DPP-4i/met (51.3%) or DPP-4i/SGLT2i (46.7%). Treatment persistence probability declined from 0.42 to 0.50 for all FDC categories at 500 days to 0.16–0.18 after 1500 days. Median treatment duration was longest with DPP-4i/SGLT2i (503 days) vs DPP-4i/met (434 days) or DPP-4i/TZD (322 days). Compared with DPP-4i/met, discontinuation was less frequent with DPP-4i/SGLT2i (hazard ratio, 0.9; 95% confidence interval: 0.89–0.92). Discontinuation or switching to another drug class was more likely among older patients or those with comorbidities, including metastatic cancer and congestive heart failure. This real-world evaluation of FDC treatment in Japanese patients with T2D provides new insights into current practice.