March 12, 2012 — Patients with diabetes who begin taking statins after they have started oral antidiabetic drugs (OADs) are more likely to discontinue statin treatment than patients who start receiving statins before initiating OADs, report Egbert J.F. Lamberts, PharmD, MBA, from the Division of Pharmacoepidemiology and Clinical Pharmacology at the Utrecht Institute for Pharmaceutical Sciences, the Netherlands, and colleagues. The team published their findings in the March issue of Diabetes and Metabolism Research and Reviews.
”Despite recommendations in treatment guidelines to initiate statin therapy in patients with type 2 diabetes, the proportion of type 2 diabetes patients receiving statins remains low, and treatment targets are not met,” Dr. Lamberts and colleagues write.
According to the researchers, previous studies have not compared adherence to treatment in patients who use statins before the initiation of OADs vs adherence in those who start statins after they are taking OADs.
The current study, therefore, sought to describe discontinuation of statins before and after initiation of OADs, and to compare discontinuation rates between the 2 treatments.
The researchers conducted an observational cohort study among 2072 patients who both initiated statins and were taking OADs between 1999 and 2007. The team identified patients through drug dispensing data from 17 community pharmacies or general practices in the West-Friesland region of the Netherlands.
The authors found that discontinuation rates for statins were higher compared with those for OADs (52.1% vs 15.0%) overall. In addition, patients who started taking statins after they had started OADs were more likely to discontinue statin use (62.8%) than those patients who initiated statins before OADs (48.2%).
”Although this study showed that the number of type 2 diabetes patients receiving statins increased considerably between 1999 and 2007, 52.1% of these patients discontinued statin treatment in the subsequent years,” Dr. Lamberts and colleagues note. ”Moreover, patients discontinued statin treatment more frequently than their oral anti-diabetic treatment,” they add.
The authors suggest that the findings are ”intriguing,” given that the 2 treatment types have ”at least comparable risks of bothersome side effects.”
”It is plausible that patients who already used statins before starting oral anti-diabetics more often have additional indications for initiating statins, such as familial hypercholesterolemia or secondary prevention in relation to cardiovascular morbidity,” and this may ”result in higher awareness of severity,” the authors suggest.
The division employing Dr. Lamberts and 2 coauthors has received unrestricted funding for pharmacoepidemiological research from GlaxoSmithKline and Novo Nordisk. The other authors have disclosed no relevant financial relationships.
Diabetes Metab Res Rev. 2012;28:241-245. Abstract
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