Reasons for discontinuation of GLP1 receptor agonists: data from a real-world cross-sectional survey of physicians and their patients with type 2 diabetes

Abstract

AimNonadherence to glucagon-like peptide-1 receptor agonists (GLP1 RAs) is relatively common among patients with type 2 diabetes mellitus (T2DM). This study sought to identify reasons why patients discontinue GLP1 RAs.Materials and methodsRetrospective data from the Adelphi Diabetes Disease Specific Programme were used. Physicians managing patients with T2DM were surveyed via face-to-face interviews, and patients treated for T2DM were surveyed via self-completed questionnaires. Patient data were stratified by current versus prior GLP1 RA use.ResultsPhysicians (n=443) most frequently reported inadequate blood glucose control (45.6%), nausea/vomiting (43.8%), and gastrointestinal (GI) side effects (36.8%) as reasons for GLP1 RA discontinuation. Patients (n=194) reported the GI-related issues “Made me feel sick” (64.4%) and “Made me throw up” (45.4%) as their top reasons for discontinuation. The most common problems reported (excluding cost) for those currently using GLP1 RAs were “Prefer oral medication over injections” (patients 56%, physicians 32.6%), “Made me feel sick” (patients 38.1%, physicians 16.3%), and “Did not help lose weight” (patients 25.4%, physicians 18%). The most bothersome problems for patients globally (frequency reporting very/extremely bothersome) (excluding cost) were “Difficult to plan meals around” (55.6%), “Made me throw up” (51.6%), and “Caused weight gain” (50%).ConclusionBoth patients and physicians reported GI-related issues as a prominent factor, but disparities between patient experiences and physician perceptions were revealed, suggesting gaps in physician–patient communication. Understanding patients’ expectations of GLP1 RAs and physicians’ patient-management practices may help increase GLP1 RA adherence and thereby potentially enhance diabetes care.

Efficacy and Safety of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide in Type 2 Diabetes Inadequately Controlled on Basal Insulin and Metformin: The LixiLan-L Randomized Trial

“…This is most likely because of the gradual increase of the Lixi dose that follows in parallel to the iGlar titration guided by FPGs and tolerance, which clearly mitigates the gastrointestinal AEs. This is a very relevant result given that gastrointestinal AEs were among the main reasons for discontinuation of GLP-1 RAs in a real-world patient survey (16). Although an indirect comparison, these results compare favorably with those of the GetGoal Duo-2 trial (12), in which Lixi given sequentially as an add-on to basal insulin achieved HbA 1c levels of 7.2% in a similar population, and suggest that iGlar plus Lixi given simultaneously as iGlarLixi may be highly effective in a population requiring further treatment intensification despite prior basal insulin treatment.…”

Benefits of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide, Versus Insulin Glargine and Lixisenatide Monocomponents in Type 2 Diabetes Inadequately Controlled on Oral Agents: The LixiLan-O Randomized Trial

“…Perhaps, to support the hypothesis that simultaneous administration with iGlarLixi is more effective and better tolerated than sequentially adding Lixi to basal insulin, the findings of the GetGoal-Duo 1 study may provide some valid hints. Although not directly comparable, in part due to no capping (free titration) of iGlar dose, the GetGoalDuo 1 study in a similar patient population, which started basal iGlar first and then added Lixi 3 months later in those whose HbA 1c was .7%, achieved a final HbA 1c of 7.0%, and 56% of participants reached HbA 1c ,7% by using the sequential regimen (10). In the current study, however, the final HbA 1c was 6.5%, and 74% of patients reached the goal of HbA 1c ,7%.…”

“…More specifically, concerns about hypoglycemia risk and weight gain (8,9) often delay insulin initiation for many years, and gastrointestinal adverse events (GI AEs) such as nausea and vomiting make GLP-1 RA intolerable for some patients, prompting low adherence and frequent drug discontinuation (10).…”

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non‐alcoholic fatty liver disease

“…[1][2][3][4][5] However, weight maintenance is challenging, with weight regain of ~55% at 4-18 months in clinical trials. 14 Gastrointestinal adverse effects, plateau of weight loss, daily injections and cost limit the duration of GLP-1 agonist usage, 15,16 with 30%-40% of outpatients stopping treatment before 1 year. 16 The sustainability of benefits in NAFLD after GLP-1 agonist discontinuation is unknown.…”

“…14 Gastrointestinal adverse effects, plateau of weight loss, daily injections and cost limit the duration of GLP-1 agonist usage, 15,16 with 30%-40% of outpatients stopping treatment before 1 year. 16 The sustainability of benefits in NAFLD after GLP-1 agonist discontinuation is unknown. We therefore compared the effects of liraglutide with that of supervised diet and exercise in obese adults with NAFLD over 26 weeks, and after another 26 weeks of weight maintenance after discontinuing interventions.…”