Only 2 out of 10 are prescribed monotherapy for diabetes

No. of triple combination therapy prescriptions for diabetes surge in Korea

Korean Diabetes Association issues ‘2022 Diabetes Fact Sheet’...8 out of 10 receive combination therapy

Use of 3-or-more drug combination therapies rise from 32% to 38% in 5 years... use of dual combination therapy fall from 42% to 40% in the same period

Growth of DPP-4 inhibitors slowing amid rapid growth... SGLT-2i sales surge, sulfonylurea sales slow

The use of combination therapies in diabetes has been increasing further.

 

Already, 8 of 10 patients are prescribed two or more drugs at once.

 

In particular, the triple therapy combination regimen seems to be rapidly establishing its presence in the field.

 

By ingredient, DPP-4 inhibitor class drugs are still showing strength, but their growth is gradually slowing down.

 

On the other hand, SGLT-2 inhibitor class drugs are gaining influence, while sulfonylurea class drugs are on a steady decline.

 

◆From dual to triple therapies…the diabetes treatment paradigm is shifting The Korean Diabetes Association published a ‘2022 Diabetes Fact Sheet’ that contained the information above.

 

Based on the national health insurance claims data, the Fact Sheet contains the prevalence, treatment rate, and drug prescription rate of diabetes in Korea from the year 2002 to 2019.

 

Present status of Oral Hypoglycemic Agent combination therapies (Data: 2022 KDA Diabetes Fact Sheet)

According to the data, the prescription rate of monotherapy in diabetes was 22.2% in 2019.

 

2 in 10 diabetes patients have been prescribed a single drug for their condition.

 

The other 77.8% are receiving two or more drugs at once.

 

The rate of combination therapy prescriptions had risen 5.4%p in 5 years from the 73.4% in 2014.

 

In particular, the prescription rate of three-or-more drug combinations is on the rise.

 

The three-or-more drug combination therapies that had been prescribed in only 31.9% of all cases until 2014, had risen 6.1%p in 5 years to 38.0%.

 

In the same period, prescription of dual combination therapies had decreased by 1.7%p from 41.5% to 39.8%.

 

Prescription of monotherapies had fallen 4.4%p in 5 years from the 26.6%.

 

The gap between prescription of dual and triple combination therapies had been 9.6%p in 2014, which had been reduced to 1.8% in 5 years.

 

The industry has been interpreting this as a shift in the diabetes treatment paradigm, of how the diabetes treatment paradigm is moving from dual combination therapies to triple combination therapies.

 

This phenomenon is also reflected in the number of drugs that are initially prescribed after being diagnosed with diabetes.

 

First drug prescription for diabetes after diagnosis (Data: 2022 KDA Diabetes Fact Sheet)

In 2009, 66.7% of the patients first diagnosed with diabetes were prescribed monotherapy.

 

The prescription rate of dual combination therapies had been 30.6%, and triple combination therapies 2.7%.

 

In 2019, the prescription rate of monotherapies in those first diagnosed with diabetes had become 58.9%, a 7.8%p decrease in 10 years.

 

On the other hand, the prescription rate of dual combination therapies had increased 4.9%p to 35.5%, and triple combination therapies 2.9%p to 5.6%.

 

◆Sales of metformin and DPP-4i surge...

 

sulfonylurea sales fall, SGLT-2i rise By ingredient, metformin and DPP-4 inhibitor class drugs are still the most popular.

 

As of 2019, 87.5% of all diabetes patients were prescribed metformin, followed by 63.9% receiving DPP-4 inhibitor class drugs, 41.7% sulfonylurea (SU), 11.6% TZD class, 10.8% SGLT-2 inhibitor class, 8.4% insulin (duplicate prescriptions reflected in the statistics).

 

Compared to 5 years ago in 2014, the prescription rate of metformin increased by 2.1%p from 85.4% to 87.5%.

 

In the case of DPP-4 inhibitors, prescriptions increased by 18.5%p from 45.4% to 63.9% in the same period.

 

After it was first introduced in 2008, the prescription of DPP-4 inhibitors increased rapidly to reach 59.1% in 2016.

 

However, since then, its growth slowed to 61.8% in 2017, 63.4% in 2018, and 63.9% in 2019.

 

Analysis of prescription patterns by diabetes drug ingredient (Data: 2022 KDA Diabetes Fact Sheet)

In the case of sulfonylurea, sales are on a constant decline.

 

Although it had been the most-prescribed drug until 2009, the prescription rate of sulfonylurea started to slow down with the introduction of DPP-4 inhibitors.

 

Due to this the prescription rate of sulfonylurea class drugs, which had reached 75.8% in 2009, fell to 51.2% in 2015, and then was overtaken by sales of DPP-4 inhibitors.

 

Sales continued to decrease further to 41.7% in 2019.

 

On the other hand, SGLT-2 inhibitor class drugs have been rapidly increasing their influence since their introduction in 2014.

 

Their prescription rate, which had been only 2.4% in 2015, rose to 10.8% in 2019.