Show simple item record

dc.contributor.authorShields, BM
dc.contributor.authorAngwin, CD
dc.contributor.authorShepherd, MH
dc.contributor.authorBritten, N
dc.contributor.authorJones, AG
dc.contributor.authorSattar, N
dc.contributor.authorHolman, R
dc.contributor.authorPearson, ER
dc.contributor.authorHattersley, AT
dc.date.accessioned2022-12-13T14:09:08Z
dc.date.issued2022-12-07
dc.date.updated2022-12-13T13:24:04Z
dc.description.abstractPatient preference is very important for medication selection in chronic medical conditions, like type 2 diabetes, where there are many different drugs available. Patient preference balances potential efficacy with potential side effects. As both aspects of drug response can vary markedly between individuals, this decision could be informed by the patient personally experiencing the alternative medications, as occurs in a crossover trial. In the TriMaster (NCT02653209, ISRCTN12039221), randomized double-blind, three-way crossover trial patients received three different second- or third-line once-daily type 2 diabetes glucose-lowering drugs (pioglitazone 30 mg, sitagliptin 100 mg and canagliflozin 100 mg). As part of a prespecified secondary endpoint, we examined patients' drug preference after they had tried all three drugs. In total, 448 participants were treated with all three drugs which overall showed similar glycemic control (HbA1c on pioglitazone 59.5 sitagliptin 59.9, canagliflozin 60.5 mmol mol-1, P = 0.19). In total, 115 patients (25%) preferred pioglitazone, 158 patients (35%) sitagliptin and 175 patients (38%) canagliflozin. The drug preferred by individual patients was associated with a lower HbA1c (mean: 4.6; 95% CI: 3.9, 5.3) mmol mol-1 lower versus nonpreferred) and fewer side effects (mean: 0.50; 95% CI: 0.35, 0.64) fewer side effects versus nonpreferred). Allocating therapy based on the individually preferred drugs, rather than allocating all patients the overall most preferred drug (canagliflozin), would result in more patients achieving the lowest HbA1c for them (70% versus 30%) and the fewest side effects (67% versus 50%). When precision approaches do not predict a clear optimal therapy for an individual, allowing patients to try potential suitable medications before they choose long-term therapy could be a practical alternative to optimizing treatment for type 2 diabetes.en_GB
dc.description.sponsorshipMedical Research Council (MRC)en_GB
dc.description.sponsorshipNational Institute for Health and Care Research (NIHR)en_GB
dc.format.extent1-8
dc.format.mediumPrint-Electronic
dc.identifier.citationPublished 7 December 2022en_GB
dc.identifier.doihttps://doi.org/10.1038/s41591-022-02121-6
dc.identifier.grantnumberMR/N00633X/1en_GB
dc.identifier.urihttp://hdl.handle.net/10871/132019
dc.identifierORCID: 0000-0003-3785-327X (Shields, Beverley M)
dc.identifierORCID: 0000-0002-0935-5284 (Angwin, Catherine D)
dc.identifierORCID: 0000-0002-0883-7599 (Jones, Angus G)
dc.identifierScopusID: 7407101887 (Jones, Angus G)
dc.identifierORCID: 0000-0001-5620-473X (Hattersley, Andrew T)
dc.language.isoenen_GB
dc.publisherNature Researchen_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/36477734en_GB
dc.rights© The Author(s) under exclusive license to Springer Nature America, Inc. 2022. For the purpose of open access, the author has applied a ‘Creative Commons Attribution (CC BY) license to any author-accepted manuscript version arising.en_GB
dc.titlePatient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster studyen_GB
dc.typeArticleen_GB
dc.date.available2022-12-13T14:09:08Z
dc.identifier.issn1078-8956
exeter.place-of-publicationUnited States
dc.descriptionThis is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recorden_GB
dc.descriptionData availability: To minimize the risk of patient re-identification, de-identified individual patient-level clinical data are available under restricted access. Requests for access to anonymized individual participant data (IPD) and study documents should be made to the corresponding author and will be reviewed by the Peninsula Research Bank Steering Committee. Access to data through the Peninsula Research Bank will be granted for requests with scientifically valid questions by academic teams with the necessary skills appropriate for the research. Data that can be shared will be released with the relevant transfer agreement.en_GB
dc.descriptionCode availability: Requests for access to code should be made to the corresponding author and will be reviewed by the Peninsula Research Bank Steering Committee. Access to code through the Peninsula Research Bank will be granted for requests with scientifically valid questions by academic teams with the necessary skills appropriate for the research. Code will be released by the lead statistician.en_GB
dc.identifier.eissn1546-170X
dc.identifier.journalNature Medicineen_GB
dc.relation.ispartofNat Med
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2022-11-07
rioxxterms.versionAMen_GB
rioxxterms.licenseref.startdate2022-12-07
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2022-12-13T14:04:11Z
refterms.versionFCDAM
refterms.dateFOA2022-12-13T14:09:09Z
refterms.panelAen_GB
refterms.dateFirstOnline2022-12-07


Files in this item

This item appears in the following Collection(s)

Show simple item record

© The Author(s) under exclusive license to Springer Nature America, Inc. 2022. For the purpose of open access, the author has applied a ‘Creative Commons Attribution (CC BY) license to any author-accepted manuscript version arising.
Except where otherwise noted, this item's licence is described as © The Author(s) under exclusive license to Springer Nature America, Inc. 2022. For the purpose of open access, the author has applied a ‘Creative Commons Attribution (CC BY) license to any author-accepted manuscript version arising.