Identification of subgroups of patients with type 2 diabetes with differences in renal function preservation, comparing patients receiving sodium-glucose co-transporter-2 inhibitors with those receiving dipeptidyl peptidase-4 inhibitors, using a supervised machine-learning algorithm (PROFILE study): A retrospective analysis of a Japanese commercial medical database.
AIMS: To investigate the effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors on renal function preservation (RFP) using real-world data of patients with type 2 diabetes in Japan, and to identify which subgroups of patients obtained greater RFP benefits with SGLT2 inhibitors vs. DPP-4 inhibitors.
METHODS: We retrospectively analysed claims data recorded in the Medical Data Vision database in Japan of patients with type 2 diabetes (aged >/=18 years) prescribed any SGLT2 inhibitor or any DPP-4 inhibitor between May 2014 and September 2016 (identification period), in whom estimated glomerular filtration rate (eGFR) was measured at least twice (baseline, up to 6 months before the index date; follow-up, 9 to 15 months after the index date) with continuous treatment until the follow-up eGFR. The endpoint was the percentage of patients with RFP, defined as no change or an increase in eGFR from baseline to follow-up. A proprietary supervised learning algorithm (Q-Finder; Quinten, Paris, France) was used to identify the profiles of patients with an additional RFP benefit of SGLT2 inhibitors vs. DPP-4 inhibitors.
RESULTS: Data were available for 990 patients prescribed SGLT2 inhibitors and 4257 prescribed DPP-4 inhibitors. The proportion of patients with RFP was significantly greater in the SGLT2 inhibitor group (odds ratio 1.27; P = 0.01). The Q-Finder algorithm identified four clinically relevant subgroups showing superior RFP with SGLT2 inhibitors (P < 0.1): no hyperlipidaemia and eGFR >/=79 mL/min/1.73 m(2) ; eGFR >/=79 mL/min/1.73 m(2) and diabetes duration </=1.2 years; eGFR >/=75 mL/min/1.73 m(2) and use of antithrombotic agents; and haemoglobin </=13.4 g/dL and LDL cholesterol >/=95.1 mg/dL. In each profile, glycaemic control was similar in the two groups.
CONCLUSION: SGLT2 inhibitors were associated with more favourable RFP vs. DPP-4 inhibitors in patients with certain profiles in real-world settings in Japan.
|ジャーナル名||Diabetes, obesity & metabolism|
|投稿者||Zhou, Fang L; Watada, Hirotaka; Tajima, Yuki; Berthelot, Mathilde; Kang, Dian; Esnault, Cyril; Shuto, Yujin; Maegawa, Hiroshi; Koya, Daisuke|
|組織名||Real World Evidence Generation, Sanofi, Bridgewater, New Jersey.;Department of Metabolism and Endocrinology, Juntendo University Graduate School;of Medicine, Tokyo, Japan.;Medical Affairs, Sanofi K.K., Tokyo, Japan.;Data Science Consulting, Quinten, Paris, France.;Department of Medicine, Shiga University of Medical Science, Otsu, Japan.;Department of Diabetology and Endocrinology, Kanazawa Medical University,;Uchinada, Japan.|