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Assessment of channeling bias among initiators of glucose-lowering drugs: A UK cohort study

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Ankarfeldt, MZ ; Thorsted, Brian Larsen ; Groenwold, Rolf Hh ; Adalsteinsson, Erpur ; Ali, M Sanni ; Klungel, Olaf H. / Assessment of channeling bias among initiators of glucose-lowering drugs : A UK cohort study. In: Clinical Epidemiology. 2017 ; Vol. 9. pp. 19-30.

Bibtex

@article{9e7cec1e30804ca1bf158538c4574b0b,
title = "Assessment of channeling bias among initiators of glucose-lowering drugs: A UK cohort study",
abstract = "BACKGROUND: Channeling bias may occur when a newly marketed drug and an established drug, despite similar indications, are prescribed to patients with different prognostic characteristics (ie, confounding).AIM: To investigate channeling bias and its impact on relative effectiveness of glucagon-like peptide-1 (GLP-1) analogs versus basal insulin and dipeptidyl peptidase-4 inhibitors (DPP-4i) versus sulfonylurea.METHODS: In the UK Clinical Practice Research Datalink, patients with type 2 diabetes initiating treatment between 2006 and 2015 were included. Analyses were stratified by years since first prescription of GLP-1 and DPP-4i, respectively. The characteristics of GLP-1 versus insulin and DPP-4i versus sulfonylurea initiators were compared over time. After propensity score matching, the relative effectiveness regarding 6-month changes in glycated hemoglobin (HbA1c) and body weight was estimated.RESULTS: In total, 8,398 GLP-1, 14,807 insulin, 24,481 DPP-4i, and 33,505 sulfonylurea initiators were identified. No major channeling was observed. Considerable overlap in distributions of characteristics allowed for propensity score-matched analyses. Relative effectiveness was similar across time. The overall relative effect of GLP-1 versus insulin showed no difference for HbA1c and relative increase in body weight (3.57 kg [95{\%} confidence interval {CI}: 3.21, 3.92]) for insulin. The overall relative effect of DPP-4i versus sulfonylurea showed relative decrease in HbA1c (-0.34{\%} [95{\%} CI: -0.38, -0.30]) and increase in body weight (1.58 kg [95{\%} CI: 1.38, 1.78]) for sulfonylurea.CONCLUSION: No major channeling was identified in the investigated glucose-lowering drugs. Relative effectiveness could be estimated already in the first year after launch and was consistent in the years thereafter.",
keywords = "Journal Article",
author = "MZ Ankarfeldt and Thorsted, {Brian Larsen} and Groenwold, {Rolf Hh} and Erpur Adalsteinsson and Ali, {M Sanni} and Klungel, {Olaf H}",
year = "2017",
doi = "10.2147/CLEP.S124054",
language = "English",
volume = "9",
pages = "19--30",
journal = "Clinical Epidemiology",
issn = "1179-1349",
publisher = "Dove Medical Press Ltd",

}

RIS

TY - JOUR

T1 - Assessment of channeling bias among initiators of glucose-lowering drugs

T2 - A UK cohort study

AU - Ankarfeldt, MZ

AU - Thorsted, Brian Larsen

AU - Groenwold, Rolf Hh

AU - Adalsteinsson, Erpur

AU - Ali, M Sanni

AU - Klungel, Olaf H

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Channeling bias may occur when a newly marketed drug and an established drug, despite similar indications, are prescribed to patients with different prognostic characteristics (ie, confounding).AIM: To investigate channeling bias and its impact on relative effectiveness of glucagon-like peptide-1 (GLP-1) analogs versus basal insulin and dipeptidyl peptidase-4 inhibitors (DPP-4i) versus sulfonylurea.METHODS: In the UK Clinical Practice Research Datalink, patients with type 2 diabetes initiating treatment between 2006 and 2015 were included. Analyses were stratified by years since first prescription of GLP-1 and DPP-4i, respectively. The characteristics of GLP-1 versus insulin and DPP-4i versus sulfonylurea initiators were compared over time. After propensity score matching, the relative effectiveness regarding 6-month changes in glycated hemoglobin (HbA1c) and body weight was estimated.RESULTS: In total, 8,398 GLP-1, 14,807 insulin, 24,481 DPP-4i, and 33,505 sulfonylurea initiators were identified. No major channeling was observed. Considerable overlap in distributions of characteristics allowed for propensity score-matched analyses. Relative effectiveness was similar across time. The overall relative effect of GLP-1 versus insulin showed no difference for HbA1c and relative increase in body weight (3.57 kg [95% confidence interval {CI}: 3.21, 3.92]) for insulin. The overall relative effect of DPP-4i versus sulfonylurea showed relative decrease in HbA1c (-0.34% [95% CI: -0.38, -0.30]) and increase in body weight (1.58 kg [95% CI: 1.38, 1.78]) for sulfonylurea.CONCLUSION: No major channeling was identified in the investigated glucose-lowering drugs. Relative effectiveness could be estimated already in the first year after launch and was consistent in the years thereafter.

AB - BACKGROUND: Channeling bias may occur when a newly marketed drug and an established drug, despite similar indications, are prescribed to patients with different prognostic characteristics (ie, confounding).AIM: To investigate channeling bias and its impact on relative effectiveness of glucagon-like peptide-1 (GLP-1) analogs versus basal insulin and dipeptidyl peptidase-4 inhibitors (DPP-4i) versus sulfonylurea.METHODS: In the UK Clinical Practice Research Datalink, patients with type 2 diabetes initiating treatment between 2006 and 2015 were included. Analyses were stratified by years since first prescription of GLP-1 and DPP-4i, respectively. The characteristics of GLP-1 versus insulin and DPP-4i versus sulfonylurea initiators were compared over time. After propensity score matching, the relative effectiveness regarding 6-month changes in glycated hemoglobin (HbA1c) and body weight was estimated.RESULTS: In total, 8,398 GLP-1, 14,807 insulin, 24,481 DPP-4i, and 33,505 sulfonylurea initiators were identified. No major channeling was observed. Considerable overlap in distributions of characteristics allowed for propensity score-matched analyses. Relative effectiveness was similar across time. The overall relative effect of GLP-1 versus insulin showed no difference for HbA1c and relative increase in body weight (3.57 kg [95% confidence interval {CI}: 3.21, 3.92]) for insulin. The overall relative effect of DPP-4i versus sulfonylurea showed relative decrease in HbA1c (-0.34% [95% CI: -0.38, -0.30]) and increase in body weight (1.58 kg [95% CI: 1.38, 1.78]) for sulfonylurea.CONCLUSION: No major channeling was identified in the investigated glucose-lowering drugs. Relative effectiveness could be estimated already in the first year after launch and was consistent in the years thereafter.

KW - Journal Article

U2 - 10.2147/CLEP.S124054

DO - 10.2147/CLEP.S124054

M3 - Journal article

VL - 9

SP - 19

EP - 30

JO - Clinical Epidemiology

JF - Clinical Epidemiology

SN - 1179-1349

ER -

ID: 50609999