medwireNews: Allowing people to try out medications for type 2 diabetes and choose their preferred one is a viable approach in the absence of a clear clinical indication, say the TriMaster investigators.
“Most patients’ preference was for the drug resulting in the best glucose control,” say Andrew Hattersley (University of Exeter, UK) and co-researchers.
The prespecified secondary analysis involved 457 participants in the TriMaster trial who tried all three study medications (pioglitazone, sitagliptin, and canagliflozin) for 16 weeks each and ranked them in order of preference.
Before being given information about on-treatment changes in their glycated hemoglobin (HbA1c) and weight, the participants’ first choices were as follows: 37% canagliflozin; 33% sitagliptin; 24% pioglitazone; and 6% no preference.
Participants chose their preferred medication mostly on the basis of “feeling better” (52%) and “lack of side effects” (38%).
Being given information on their medication response caused 27% of participants to change their first choice of treatment, although this changed the overall ranking only slightly. Over three-quarters of those who changed did so on the basis of their HbA1c result (55% because of this alone) and 29% did so because of weight changes (8% for only this reason). The proportion of people with no preference fell from 5.9% to 2.0%.
That participants ranked HbA1c over weight loss when choosing medications was “unexpected,” say the researchers, although they concede this “might reflect the relatively modest changes seen in weight in the study, potentially due to the relatively short treatment with each drug.”
Hattersley and team note that allowing participants to take their first-choice medication would result in 70% taking the one that resulted in the lowest HbA1c and 67% the one associated with the lowest number of side effects.
“In contrast if all had been allocated canagliflozin (the drug most likely to be preferred in this study), only 30% would be on the on the drug with the lowest HbA1c and 50% on the drug with the lowest number of side effects,” they write in Nature Medicine.
Before feedback on treatment response, 53% of people had chosen the medication that gave the best HbA1c results; after feedback this rose to 70%, whereas there was little overall change related to side effects or weight loss.
The researchers say their findings support a patient-centered “try-before-you-choose” approach, which also “could be applicable to other chronic diseases such as hypertension.”
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