Dynamics of switching, adherence, and persistence of dipeptidyl peptidase-4 inhibitors use: a nationwide cohort study

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Aims: To characterise the patterns of switching, adherence, and persistence among adults aged ≥18 years with diabetes prescribed dipeptidyl peptidase-4 inhibitors (DPP-4is) in Australia.
Methods: The analysis included 15,915 adults newly prescribed DPP-4is (sitagliptin=9576; vildagliptin=1130; saxagliptin=1126; linagliptin=3560; and alogliptin=523). Multivariable logistic regression model was used to compare the non-adherence (proportion of days covered [PDC]<0.80) rates whereas Cox proportional hazards regression models were used to compare switching and non-persistence (≥90-day gap) among different DPP4-is over 12-months.
Results: Overall, 36.0% (5722/15,915) of DPP-4i users were non-adherent and 30.0% (4775/15,915) were non-persistent at 12-months. Compared to sitagliptin, vildagliptin, linagliptin, and alogliptin were not associated with higher non-adherence and non-persistence. However, saxagliptin was associated with a higher likelihood of being non-adherent (odds ratio 1.41, 95% confidence interval [CI] 1.23-1.60) or non-persistent (hazard ratio 1.27, 95% CI 1.15-1.42) compared to sitagliptin. Just 3.2% of people switched between different DPP-4is. Compared to sitagliptin, people initiated on vildagliptin, saxagliptin, alogliptin, and linagliptin were more likely to switch.
Conclusions: We found no significant differences in the adherence and persistence rates between alogliptin, vildagliptin or linagliptin and sitagliptin. However, saxagliptin was associated with higher non-adherence and non-persistence compared to sitagliptin. Switching was lowest amongst users of sitagliptin.
Original languageEnglish
Article number107909
Number of pages21
JournalDiabetes Research and Clinical Practice
Publication statusPublished - 1 Dec 2019


  • Adherence
  • Antihyperglycemic agents
  • DPP-4is
  • Persistence
  • Switching

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