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Eunjung Choo,1,* Minji Jung,1,* Jaekyu Shin,2 Sukhyang Lee1 1Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea; 2Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, USA*These authors contributed equally to this workCorrespondence: Sukhyang LeeDivision of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of KoreaTel +82-31-219-3443Fax +82-31-219-3435Email suklee@ajou.ac.krPurpose: Numerous studies have utilized various forms of adherence measures. However, methods for measuring adherence are inconsistent. Moreover, few studies are available that have compared sensitivities of the effects of several criteria on medication adherence. This study aims to compare measures of adherence using varied analytical decisions.Materials and Methods: We included three measures for adherence: proportion of days covered with one or more medications (PDCwith≥ 1), duration weighted mean PDC (PDCwm), and daily polypharmacy possession ratio (DPPR). We compared the sensitivities of the measures by changing parameters in the Korean nationwide claims database. First, we used PDCwith≥ 1 as our base model. Then, we divided an adherence measure algorithm into three categories: (1) definition of data cleaning, (2) inclusion criteria and observation period, and (3) calculation methods of medication adherence. The categories included eight decision nodes that incorporated 25 alternative options. Finally, we assessed the medication adherence for the base-case with commonly used values and then varied to measure with each alternative option.Results: The base-case included 14,288 beneficiaries with antihypertensives. Among eight decisions, both handling an end-date-of-study and overlaps had the strongest impacts on measuring PDCwith≥ 1, PDCwm, and DPPR, with small differences in sample size. Instead of the estimates of adh

Minji Jung,* Eunjung Choo,* Sukhyang Lee Division of Clinical Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea*These authors contributed equally to this workCorrespondence: Sukhyang LeeDivision of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-Ro Yeongtong-Gu, Suwon 16499, Republic of KoreaTel +82-31-219-3443Fax +82-31-219-3435Email suklee@ajou.ac.krPurpose: The number of people receiving antihypertensive prescriptions in Korea has increased more than threefold from 2002 to 2016. However, previous studies regarding the current use of these medications have been fairly limited. We aimed to examine the current trends and changes in the patterns of antihypertensive prescriptions based on a nationwide claims database.Patients and Methods: Patients receiving antihypertensive medications over 30 days, without any limited therapeutic indication, were identified using the Health Insurance Review and Assessment Service (HIRA) database between 2015 and 2017. For each patient, the use of antihypertensive medication was specified as the class of drug used for the longest duration in each year.Results: A total of 8,625,821 patients in 2015, 8,997,829 patients in 2016, and 9,357,751 patients in 2017 taking antihypertensives were included in this study. Angiotensin II receptor blockers (ARB) (35.9% in 2015 and 38.9% in 2017) and calcium channel blockers (CCB) (37.1% in 2015 and 35.2% in 2017) for monotherapy, ARB+CCB combinations (49.3% in 2015 and 56.3% in 2017) for dual therapy, and ARB+CCB+diuretics combinations (48.8% in 2015 and 48.9% in 2017) for more than triple therapy were the most frequently prescribed. Subjects aged ≥ 70 showed the highest prescription rate of antihypertensives compared with those < 70; however, a decreasing trend presented from 62.3% in 2015 to 54.2% in 2017. Additionally, in subjects aged > 70 years, the rate in women was higher than that in men, but this was reversed in younger patie

Yoojin Noh,1 Sukhyang Lee,1,2 Sooyoung Shin1,2 1Department of Clinical Pharmacy, College of Pharmacy, Ajou University, Yeongtong-gu, Suwon, Republic of Korea; 2Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Yeongtong-gu, Suwon, Republic of Korea Background: As newly available antidiabetic drugs (ADs) are used more commonly as initial hypoglycemic choice for early stage diabetes patients, there is an urgent need to investigate how these agents may differ in treatment durability relative to metformin. This study aimed to investigate the incidence and risk of treatment adjustment among newly treated type 2 diabetes mellitus (T2DM) patients receiving an oral AD as initial monotherapy. Methods: T2DM patients registered in the National Health Insurance Program who were newly prescribed an oral AD were identified. Time to treatment addition or switch to alternative antidiabetic therapy was determined using the Kaplan–Meier survival analysis. Cox proportional hazards regression was performed to estimate the hazard ratio (HR) after adjusting for potential confounding factors. Results: The median time to treatment adjustment was shorter for sulfonylureas (SUs), dipeptidyl peptidase-4 (DPP-4) inhibitors, alpha-glucosidase (AG) inhibitors, and thiazolidinediones (TZDs) compared to that for metformin. Initiation of therapy with SUs or DPP-4 inhibitors was associated with a significantly higher risk of both treatment addition and switching than with metformin (HR 1.49 versus 1.47 for overall treatment adjustment, respectively). In contrast, among incident users of AG inhibitors or TZDs, only the hazard of switch was substantially increased compared to metformin starters (6.19, 95% confidence interval [CI] 5.77–6.64 and 7.31, 95% CI 6.35–8.42, respectively). When addition and switch events were collectively assessed, the risk of treatment adjustment was significantly elevated in all non-metformin cohorts. Conclus