Glucagon-Like Peptide-1 Receptor Agonist Treatment Patterns Among Type 2 Diabetes Patients in Six European Countries

Abstract

IntroductionThe objective of this study was to evaluate real-world treatment patterns of type 2 diabetes (T2D) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Germany (GE), the United Kingdom (UK), France (FR), the Netherlands (NE), Belgium (BE), and Sweden (SE).MethodsAdult T2D patients initiating exenatide twice daily (exBID), liraglutide once daily (LIRA) or exenatide once weekly (exQW) were identified using the IMS LifeLink™ (IMS Health, Danbury, CT, USA): Electronic Medical Records (EMR; GE/UK/FR) and IMS LifeLink™: longitudinal prescriptions (LRx; NE/BE/GE/UK) databases, and national health register data (SE), between 2010 and 2012. Therapy initiation date was termed ‘index date’. Eligible patients had ≥180-day pre- and variable follow-up (minimum ≥360-day post-index exBID and LIRA, ≥180-day post-index exQW). Treatment modification and persistence were evaluated over 180 days. Kaplan–Meier (KM) survival curves and Cox proportional hazards models (PHMs; EMR databases only) evaluated stopping of the index therapy (measured as first of discontinuation or switch).Results30,206 exBID, 5,401 exQW, and 52,155 LIRA patients were included in the analysis (46.0–66.9% male; mean age range 55.4–59.3 years). Mean follow-up was 20.3–27.4 months for exBID and LIRA, and 7.6–13.9 months for exQW. Across the databases, the proportion experiencing a treatment modification at 180 days was highest among exBID (37.6–81.7%) compared to LIRA (36.8–56.6%) and exQW (32.3–47.7%). The proportion persistent at 180 days was lowest among exBID patients (46.8–73.5%) compared to LIRA (50.6–80.1%) or exQW (57.5–74.6%). In the KM analyses, LIRA patients had a lower proportion stopping therapy at all time points compared to exBID patients, across the databases. In the Cox PHMs, LIRA was associated with a significantly lower risk of stopping compared to exBID; in GE, exQW was associated with a lower risk compared to exBID and LIRA.ConclusionTreatment patterns varied among GLP-1 RA patients, with persistence highest among either LIRA or exQW across countries, and lowest among exBID. Longer-term data would be useful, particularly given limited exQW follow-up due to more recent launch.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0087-6) contains supplementary material, which is available to authorized users.

Effectiveness of Liraglutide and Lixisenatide in the Treatment of Type 2 Diabetes: Real-World Evidence from The Health Improvement Network (THIN) Database in the United Kingdom

“…Liraglutide prescriptions were categorized as the following: all doses (any exposure to all available prescribed doses [0.6 mg, 1.2 mg, 1.8 mg per day] during the study period); 1.2 mg category, average daily dose (ADD) 0.6–1.5 mg; and liraglutide 1.8 mg category, ADD >1.5–2.1 mg [12]. ADD was calculated as the sum of the prescribed number of units (pens) multiplied by the total dosage in each unit (mg), divided by the sum of the days covered by the prescriptions.…”

Evaluation of the long‐term cost‐effectiveness of liraglutide vs lixisenatide for treatment of type 2 diabetes mellitus in the UK setting

“…A total of three once‐daily GLP‐1 receptor agonists are currently available to patients: exenatide 10 µg twice daily (approved by the European Medicines Agency in 2006); liraglutide 1.2 or 1.8 mg (approved in 2009); and lixisenatide 20 µg (approved in 2013). In the UK in 2013, an analysis of the prescription records of 30 436 patients receiving liraglutide found that the mean daily dose of liraglutide was 1.49 mg, reflecting an almost equal split between the 1.2 and 1.8 mg doses . However, since collection of these data, restrictions on the use of liraglutide 1.8 mg in the UK have been removed and the proportion of patients receiving liraglutide 1.8 mg is likely to increase in the future.…”

“…In the UK in 2013, an analysis of the prescription records of 30 436 patients receiving liraglutide found that the mean daily dose of liraglutide was 1.49 mg, reflecting an almost equal split between the 1.2 and 1.8 mg doses. 13 However, since collection of these data, restrictions on the use of liraglutide 1.8 mg in the UK have been removed and the proportion of patients receiving liraglutide 1.8 mg is likely to increase in the future.…”

Treatment of Type 2 Diabetes: From “Guidelines” to “Position Statements” and Back

“…Some GLAs have a low side effect profile and subsequently high rates of patient adherence to therapy, most notably DPP-4 inhibitors (33), while others do not (e.g., TZDs, SUs, GLP-1 RAs, insulin). Side effects may also partly explain why patients have higher rates of drug discontinuation in "real-world" observational trials compared with clinical trials (46). Individual patient beliefs, preferences, and specific lifestyle circumstances (for example, fear of hypoglycemia, fear of injection, high-risk occupation [drivers], tolerability of gastrointestinal side effects, etc.)…”