GLP-1 RA Treatment and Dosing Patterns Among Type 2 Diabetes Patients in Six Countries: A Retrospective Analysis of Pharmacy Claims Data

Abstract

Introduction The glucagon-like peptide-1 receptor agonist (GLP-1 RA) class is evolving and expanding. This retrospective database study evaluated recent real-world treatment and dosing patterns of patients with type 2 diabetes (T2D) initiating GLP-1 RAs in Belgium (BE), France (FR), Germany (DE), Italy (IT), the Netherlands (NL), and Canada (CA). Methods Adult T2D patients initiating GLP-1 RA therapy (dulaglutide [DULA], exenatide twice daily [exBID], exenatide once weekly [exQW], liraglutide [LIRA], or lixisenatide [LIXI]) from 2015 to 2016 were identified using the IQVIA (IQVIA, Durham, NC, and Danbury, CT, USA) Real-World Data Adjudicated Pharmacy Claims. The therapy initiation date was termed the ‘index date.’ Eligible patients had ≥ 180 days pre-index and ≥ 360 days post-index. Persistence (until discontinuation or switch) was evaluated over the variable follow-up using Kaplan–Meier (KM) survival analysis. Average daily dose (ADD) was calculated until discontinuation or switch. Results A total of 34,649 DULA, 3616 exBID, 11,138 exQW, 48,317 LIRA, and 2,204 LIXI patients were included in the analysis (34.9–63.2% female; median age range 53–62 years; median follow-up 16–30 months). Proportion persistent at 1-year post-index was 36.8–67.2% for DULA, 5.9–44.4% for exBID, 24.7–44.2% for exQW, 22.2–57.5% for LIRA, and 15.5–40.0% for LIXI. Median time persistent (days) was 245–381 for DULA, 62–243 for exBID, 121–319 for exQW, 103–507 for LIRA, and 99–203 for LIXI. Mean ADD was 13.21–20.43 µg for exBID, 1.44–1.68 mg for LIRA, and 19.88–20.54 µg for LIXI. Mean average weekly dose (AWD) ranged from 2.03 to 2.14 mg for exQW. Mean AWD for DULA was 1.25 mg in Canada and ranged from 1.43 to 1.53 mg in the other countries. Conclusion Across six countries, persistence was highest among DULA patients and generally lowest among exBID patients. ADD/AWD for all GLP-1 RAs was in line with the recommended label. Longer-term data would be useful to obtain a better understanding of GLP-1 RA treatment patterns over time. Funding Eli Lilly and Company, Indianapolis, IN, USA. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0615-5) contains supplementary material, which is available to authorized users.

<p>Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice</p>

“…Indeed, although it is generally recognized that adherence in RWS is much lower than that in the controlled setting of RCTs, this is not the same for all compounds. Adherence has been found to be higher for dulaglutide and lower for exeOW, [40][41][42][43][44] and this might be related to a simpler and easier device used for injection. 45 Confirming this hypothesis, sensitivity "as-treated" analyses focused only on those subjects with confirmed prescription of treatments at followup visits (considered as subjects with higher adherence) -Overall Adherence in RWS is lower than RCTs 37,38,46 -Adherence specifically influenced by compound/devices (eg, dulaglutide>exeOW) [40][41][42][43][44][45][46] -Different clinical characteristics between patients enrolled in RCTs vs those treated with GLP-1RAs in RWS (see Table 2) Dula 1.5 mg = Lira 1.8 mg 29 Dula > Lira 37 Dula = ExeOW (from NWMA) 33,34 Dula > ExeOW 35,37 Sema (0.5 or 1.0 mg) > Dula 1.5 mg 29 No RWS Dula = ExeOW (from NWMA) 33,34 Dula > ExeOW 35,37 Sema (0.5 or 1.0 mg) > Dula 1.5 mg 29 No RWS Note: The symbol ">" or "<" are used to describe significant higher or lower efficacy (RCTs) or effectiveness (RWS) between compounds.…”

Real-World Effectiveness of Dulaglutide in Patients with Type 2 Diabetes Mellitus: A Literature Review

“…Only two studies were of a prospective observational design: data were derived from a patient-completed questionnaire assessing medication satisfaction and adherence in one study [16] and from pharmacy records and a DM clinic portal in the other [17]. A variety of different data sources were employed in retrospective observational studies including medical records from DM/endocrinology clinics or outpatient departments in 12 records [18][19][20][21][22][23][24][25][26][27][28][29], claims databases in 7 [12,[30][31][32][33][34][35], EHR databases in 5 [36][37][38][39][40], and longitudinal prescriptions databases in 2 [41,42]. In addition, one study used a patient registry [43].…”

“…Guidelines recommend the use of GLP-1 RAs as one of the options in patients with T2DM who have failed to achieve target HbA1c levels after treatment with metformin [8]. Real-world data from prescription databases suggest that dulaglutide is initiated in patients who previously used a median of 2-3 antihyperglycemic therapy classes in the previous 6 months, most commonly biguanides or sulfonylureas [12]. Recent guideline updates have raised the priority of GLP-1 RAs, further recommending their use in patients with T2DM and atherosclerotic cardiovascular (CV) disease, at high/very high CV risk, or to reduce CV events [8,13,14].…”

Integrating oral semaglutide into clinical practice in primary care: for whom, when, and how?

“…As discussed in detail in the first article in this supplement [43], subcutaneous GLP-1RAs are currently associated with adherence/ persistence rates that indicate room for improvement [44][45][46]. While there is likely a myriad of factors contributing to these rates, in part they are likely to relate to patient and health-care provider concerns regarding injections, including perceived pain, inconvenience, and administration challenges [47][48][49][50].…”