Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.

<h4>Background</h4>Suboptimal patient adherence to pharmacological therapy of type 2 diabetes may be due in part to pill burden. One way to reduce pill burden in patients who need multiple medications is to use fixed-dose combinations. Our study aimed to compare the effects of fixed-dose...

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Autores principales:	Anna-Katharina Böhm, Udo Schneider, Jens Aberle, Tom Stargardt
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/42dcadc6d14242298812ea1e8ae50900
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spelling	oai:doaj.org-article:42dcadc6d14242298812ea1e8ae509002021-11-25T06:19:22ZRegimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.1932-620310.1371/journal.pone.0250993https://doaj.org/article/42dcadc6d14242298812ea1e8ae509002021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0250993https://doaj.org/toc/1932-6203<h4>Background</h4>Suboptimal patient adherence to pharmacological therapy of type 2 diabetes may be due in part to pill burden. One way to reduce pill burden in patients who need multiple medications is to use fixed-dose combinations. Our study aimed to compare the effects of fixed-dose combination versus loose-dose combination therapy on medication adherence and persistence, health care utilization, therapeutic safety, morbidities, and treatment modification in patients with type 2 diabetes over three years.<h4>Methods</h4>Using administrative data, we conducted a retrospective controlled cohort study comparing type 2 diabetes patients who switched from monotherapy to either a fixed-dose combination or a loose-dose combination. Adherence was assessed as the primary endpoint and calculated as the proportion of days covered with medication. After using entropy balancing to eliminate differences in observable baseline characteristics between the two groups, we applied difference-in-difference estimators for each outcome to account for time-invariant unobservable heterogeneity.<h4>Results</h4>Of the 990 type 2 diabetes patients included in our analysis, 756 were taking a fixed-dose combination and 234 were taking a loose-dose combination. We observed a statistically significantly higher change in adherence (year one: 0.22, p<0.001, year two: 0.25, p<0.001, and year three: 0.29, p<0.001) as well as higher persistence and a smaller change in the number of drug prescriptions in each of the three years in the fixed-dose combination group compared to the loose-dose combination group. The differences were most pronounced in patients who were poorly adherent, had a high pill burden, or did not have a severe concomitant disease.<h4>Conclusion</h4>Our results indicate that taking a fixed-dose combination can lead to a significant improvement in adherence to pharmacological therapy of type 2 diabetes compared to a loose-dose combination. In particular, these findings suggest that reducing pill burden may improve disease management among patients with more complex medication demand and patients who have demonstrated poor medication adherence.Anna-Katharina BöhmUdo SchneiderJens AberleTom StargardtPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0250993 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Anna-Katharina Böhm Udo Schneider Jens Aberle Tom Stargardt Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
description	<h4>Background</h4>Suboptimal patient adherence to pharmacological therapy of type 2 diabetes may be due in part to pill burden. One way to reduce pill burden in patients who need multiple medications is to use fixed-dose combinations. Our study aimed to compare the effects of fixed-dose combination versus loose-dose combination therapy on medication adherence and persistence, health care utilization, therapeutic safety, morbidities, and treatment modification in patients with type 2 diabetes over three years.<h4>Methods</h4>Using administrative data, we conducted a retrospective controlled cohort study comparing type 2 diabetes patients who switched from monotherapy to either a fixed-dose combination or a loose-dose combination. Adherence was assessed as the primary endpoint and calculated as the proportion of days covered with medication. After using entropy balancing to eliminate differences in observable baseline characteristics between the two groups, we applied difference-in-difference estimators for each outcome to account for time-invariant unobservable heterogeneity.<h4>Results</h4>Of the 990 type 2 diabetes patients included in our analysis, 756 were taking a fixed-dose combination and 234 were taking a loose-dose combination. We observed a statistically significantly higher change in adherence (year one: 0.22, p<0.001, year two: 0.25, p<0.001, and year three: 0.29, p<0.001) as well as higher persistence and a smaller change in the number of drug prescriptions in each of the three years in the fixed-dose combination group compared to the loose-dose combination group. The differences were most pronounced in patients who were poorly adherent, had a high pill burden, or did not have a severe concomitant disease.<h4>Conclusion</h4>Our results indicate that taking a fixed-dose combination can lead to a significant improvement in adherence to pharmacological therapy of type 2 diabetes compared to a loose-dose combination. In particular, these findings suggest that reducing pill burden may improve disease management among patients with more complex medication demand and patients who have demonstrated poor medication adherence.
format	article
author	Anna-Katharina Böhm Udo Schneider Jens Aberle Tom Stargardt
author_facet	Anna-Katharina Böhm Udo Schneider Jens Aberle Tom Stargardt
author_sort	Anna-Katharina Böhm
title	Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
title_short	Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
title_full	Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
title_fullStr	Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
title_full_unstemmed	Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.
title_sort	regimen simplification and medication adherence: fixed-dose versus loose-dose combination therapy for type 2 diabetes.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/42dcadc6d14242298812ea1e8ae50900
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Regimen simplification and medication adherence: Fixed-dose versus loose-dose combination therapy for type 2 diabetes.

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