Purpose: This study aims to investigate the potential causal relationship between the use of indapamide and rhabdomyolysis. Previous research and pharmacovigilance monitoring activities have suggested a potential association between indapamide use and rhabdomyolysis. However, limited information is available on this association. Methods: A case-control study conducted using EHR data, between July 1,2016, and December 31,2022. Patients who have rhabdomyolysis event (cases) were matched to four controls bases on age, gender and date. We examined the odds for indapamide exposure through three risk periods: current use, recent use, and former. The study outcome was ascertained through the presence of CK level over 1,000 U/L (i.e. rhabdomyolysis event). Subsequently, a multivariable conditional logistic regression analysis was utilized to assess the causal impact of indapamide exposure on the likelihood of developing rhabdomyolysis, while accounting for potential confounding variables. Results: The study population consisted of 2,965 cases and 11,860 controls. The results of the conditional logistic regression analysis indicated a lack of association between exposure to indapamide for the current users the OR was 0.7 (95% CI: 0.49 - 0.92) and the AOR was 0.6 (95% CI: 0.39 - 1.05). The recent users showed OR of 0.9 (95% CI: 0.56 - 1.50) and AOR of 0.2 (95% CI: 0.14 - 0.47). Lastly, the former users demonstrated an OR of 0.8 (95% CI: 0.47 - 1.26), and AOR of 0.1 (95% CI: 0.07 - 0.23). Conclusions: In this study, we did not find association between indapamide use and rhabdomyolysis regardless timing of exposure.

Purpose: Optimal adherence to antidiabetics among patients with type 2 diabetes mellitus has been associated with positive health outcomes; however, studies to assess this adherence in Saudi Arabia are scarce. We aimed to evaluate adherence to antidiabetics using a Saudi population. Methods: This was a multicenter, retrospective cohort study of patients (≥ 18 years old) with type 2 diabetes mellitus who received ≥ 1 antidiabetic between 2015 and 2020. Adherence was estimated using the continuous multiple-interval measure of medication availability (CMA7). A CMA7 cutoff point of ≥ 80% was chosen to define optimal adherence, and the odds of not achieving therapeutic annual HbA1c levels (i.e. ≥ 7%) in the optimal vs. suboptimal adherence groups was assessed using a logistic regression model adjusting for the measured confounders. Results: A total of 36,789 patients were included in the study. The most commonly prescribed regimens were metformin single treatment (n=15,025 [41.6%]) and gliclazide-metformin combination treatment (n=5,667 [15.7%]). The median CMA7 was 70.4%, and only 13,552 (36.9%) patients were adherent to their antidiabetics (CMA7 ≥ 80%). The odds of not achieving therapeutic HbA1c levels one year after the index date were comparable in the optimal vs. suboptimal adherence groups (odds ratio = 0.99, 95% confidence interval 0.92 to 1.05). Conclusions: This study showed that a large proportion of a Saudi population with type 2 diabetes mellitus were non-adherent to their antidiabetic treatments. Future Saudi and regional studies are needed to assess the impact of adherence on HbA1c levels and on cardiovascular outcomes.