Drug Utilization Review of Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Alice Ho Miu Ling Nethersole Hospital (AHNH)

Abstract

Introduction: Dipeptidyl peptidase-4 (DPP-4) inhibitor is a new class of drug for treatment of type 2 diabetes. It is listed as special drug in Hospital Authority Drug Formulary (HADF), prescribing of which should fulfill certain clinical indications and restrictions are posed to the prescribing physician. Two DPP-4 inhibitors are available in AHNH. Sitagliptin was introduced into AHNH formulary in November 2009. Vildaglitpin was available as a sample drug since June 2010. Purposes of the Project: 1. To evaluate the utilization pattern of sitagliptin and vildagliptin in AHNH 2. To compare the prescribing pattern of sitagliptin and vildagliptin with the recommendations from HADF 3. To investigate the efficacy and safety of sitagliptin and vildagliptin Method: It is a single centre, retrospective review. Patients who had been prescribed sitagliptin or vildagliptin in AHNH within the period from December 2009 to November 2010 (12 months) were identified by using an in-house developed Microsoft Access Program. Patient’s medical record and case history was assessed and reviewed by using electronic-Patient Record (e-PR) of Clinical Management System (CMS). Demographic and clinical data was collected for statistical analysis. Results: A total of 75 patients were identified, 66 (Sitagliptin: 57, Vildaglpiptin: 9) of which entered the review. For the whole population, the mean change with S.D. in HbA1c & FBG were -0.33 +/- 1.16 % (n = 66, p = 0.023) and +0.13 +/- 2.62 mmol/L (n = 57, p = 0.713) respectively. The reduction in HbA1c was statistically significant (p <0.05). The two DPP-4 inhibitors were generally well tolerated, with 3% hypoglycemia and 6% infection reported. The compliance of prescribing sitagliptin in accordance to HADF indication was checked as different parts. Sitaglitptin was prescribed properly (~ 90%). But the maintenance of the sitagliptin was not so complied (45.6%). Conclusions: DPP-4 inhibitors were generally well tolerated in AHNH patients. They were appropriately prescribed (in terms of compliance to HADF indication and dosage) in most of the AHNH patients.