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Prescribing Trends of the Sodium–Glucose Cotransporter-2 Inhibitors Among Different Physician Specialties in Canada (2015–2021)

Published:November 08, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.11.002

      Abstract

      Objectives

      Landmark clinical trials have shown the sodium–glucose cotransporter-2 (SGLT-2) inhibitors to have cardiorenal benefits beyond their glucose-lowering effect. Clinical guidelines now recommend their use in patients with chronic kidney disease or heart failure, with or without type 2 diabetes, potentially affecting prescribing patterns among physician specialties.

      Methods

      Using monthly projected total retail dispensed prescription data from IQVIA’s CompuScript database, we assessed trends in prescribing SGLT-2 inhibitors among 6 prescriber specialities from 2015 to 2021 in Canada. We assessed these trends at the class, agent and dose level using joinpoint regression.

      Results

      From 2015 to 2021, the projected total retail dispensed prescriptions of SGLT-2 inhibitors from all prescribers increased. Relative to other prescribers, >60% of SGLT-2 inhibitor prescriptions were written by general practitioners or family physicians. The percentage of prescriptions from endocrinologists decreased (average annual percent change: mean, −10.8; 95% confidence interval [CI], −12.2% to −9.4%), whereas a dramatic increase was observed for cardiologists (mean, 44.1%, 95% CI, 32.9 to 56.2). The percentage from nephrologists also increased, albeit not statistically significant (mean, 12.4; 95% CI, −0.5 to 27.1). Significant changes in the agent and dose of SGLT-2 inhibitor prescribed were also observed among cardiologists and nephrologists.

      Conclusions

      Between 2015 and 2021, there was a steady increase in the proportion of SGLT-2 inhibitors prescriptions from cardiologists and nephrologists, reflecting emerging evidence and guideline recommendations.

      Résumé

      Objectifs

      Des essais cliniques novateurs ont montré que les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) avaient des bénéfices cardiorénaux qui vont au-delà de leurs effets hypoglycémiants. Les lignes directrices de pratique clinique recommandent maintenant leur utilisation chez les patients atteints d’insuffisance rénale chronique ou d’insuffisance cardiaque, avec ou sans diabète de type 2, ce qui touche potentiellement les habitudes de prescription des médecins spécialistes.

      Méthodes

      À partir des données mensuelles sur le nombre total estimé d’ordonnances exécutées par les pharmacies au détail de la base de données CompuScript d’IQVIA, nous avons évalué les tendances de prescription des iSGLT2 de 6 spécialistes prescripteurs de 2015 à 2021 au Canada. Nous avons évalué ces tendances sur le plan de la classe, de l’agent et de la dose au moyen de la régression Joinpoint.

      Résultats

      De 2015 à 2021, le nombre total estimé d’ordonnances exécutées par les pharmacies au détail d’iSGLT2 de tous les prescripteurs avait augmenté. Par rapport aux autres prescripteurs, > 60 % des ordonnances d’iSGLT-2 étaient rédigées par des omnipraticiens ou des médecins de famille. Le pourcentage d’ordonnances des endocrinologues avait diminué (variation moyenne annuelle en pourcentage : moyenne, −10,8 ; intervalle de confiance [IC] à 95 %, de −12,2 % à −9,4 %), alors qu’une augmentation spectaculaire des ordonnances des cardiologues avait été observée (moyenne, 44,1 %, IC à 95 %, de 32,9 à 56,2). Le pourcentage des néphrologues avait aussi augmenté, quoique cette augmentation était non significative sur le plan statistique (moyenne, 12,4 ; IC à 95 %, de −0,5 à 27,1). Des variations importantes en matière d’agent et de dose des iSGLT-2 prescrits ont aussi été observées chez les cardiologues et les néphrologues.

      Conclusions

      Entre 2015 et 2021, il y a eu une augmentation constante du pourcentage des ordonnances d’iSGLT-2 des cardiologues et des néphrologues, qui reflétait les données probantes émergentes et les recommandations des lignes directrices.

      Keywords

      Mots clés

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