Glucagon-like Peptide-1 Receptor Agonist Treatment Attributes Important to Injection-Naïve Patients with Type 2 Diabetes Mellitus: A Multinational Preference Study

Abstract

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1RAs) differ in efficacy, side effects, dosing frequency, and device-related attributes. This study assessed the relative importance of treatment-related attributes in influencing preferences for GLP-1RAs among injection-naïve patients with type 2 diabetes mellitus (T2DM).MethodsInjection-naïve T2DM patients from five countries completed a Web-based discrete choice experiment (DCE) survey. Patients chose between hypothetical treatment profiles reflecting important and differentiating attributes of GLP-1RAs. Eight attributes were included: efficacy, side effects, device size, needle size, titration, preparation, evidence of long-term efficacy/safety, and dosing frequency. Odds ratios (ORs) and 95% confidence intervals were calculated using a conditional logit model to indicate the likelihood of choosing a treatment with a given attribute level versus a reference attribute level. The influence of individual attributes when considering full treatment profiles was examined using exenatide once weekly (QW) and liraglutide once daily (QD) as case examples.ResultsA total of 1482 patients with T2DM completed the DCE survey. Side effects, efficacy, and dosing frequency were the three most important attributes influencing preferences; needle size, device size, and required preparation were least important. Total sample analysis indicated that a profile of GLP-1RA approximating exenatide QW (single pen) was preferred over a profile approximating liraglutide QD (OR 3.36; p < 0.001), when efficacy was assumed to be equal.ConclusionThe most influential drivers of treatment preferences for a hypothetical GLP-RA profile were side effects, efficacy, and dosing frequency among injection-naïve T2DM patients. Preference elicitation can promote patient-centered care and inform new generations of T2DM treatments, which can lead to improved adherence and health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0230-2) contains supplementary material, which is available to authorized users.

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

“…It is possible that the higher persistence observed with dulaglutide may be related to dulaglutide’s convenient dosing schedule and ready-to-use single dose pen. Dosing frequency, ease of preparation, and delivery system have been identified as key drivers of patient preference for GLP-1 RAs [ 48 – 50 ]. Patient preference studies conducted in the UK and Japan have suggested an overall preference for dulaglutide compared to liraglutide [ 50 , 51 ].…”

Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment

“…While a multitude of factors can affect treatment adherence, treatment-related issues (e.g. treatment complexity, convenience, cost) are among those considered especially important 11,14 . Adherence improves as dosing frequency decreases, for example, from once daily to once weekly 11,21 .…”

“…As many as 55% of patients do not adhere to their prescribed diabetes treatment regimen 6 , compromising the effectiveness of therapy and raising associated costs, healthcare utilization and even mortality risk [7][8][9][10][11][12][13] . Patient adherence to a given medication can be affected by many factors, including dosing regimens, medication costs and general patient preferences 14 . In patients with T2DM, adherence has been shown to increase with the use of prefilled pens compared with vials and syringes for administration of basal insulin 11,[15][16][17][18][19][20] , and through simplified dosing regimens 11,21 .…”

Hold the device against the skin: the impact of injection duration on user’s force for handheld autoinjectors

“…The growing interest in subcutaneous injection of large-volume single doses up to 2 mL or more can be attributed to three major causes. First, dosing frequency has been identified as an important factor driving treatment choices across disease states [20][21][22]. In fact, the complexity of the dosing regimen in terms of frequency, flexibility, and timing has a greater importance on patient perceptions than the efficacy and safety profile of drugs [23].…”