Treatment patterns in patients with type 2 diabetes mellitus treated with glucagon‐like peptide‐1 receptor agonists: Higher adherence and persistence with dulaglutide compared with once‐weekly exenatide and liraglutide

Abstract

AimsTo compare adherence (proportion of days covered [PDC]), persistence, and treatment patterns among patients with type 2 diabetes mellitus (T2DM) newly initiating glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs). More specifically, the main objectives were to compare dulaglutide vs exenatide once weekly and dulaglutide vs liraglutide.MethodsPatients with T2DM newly initiating dulaglutide, albiglutide, exenatide once weekly, exenatide twice daily and liraglutide between November 2014 and April 2015 were hierarchically selected from Truven Health's MarketScan Research Databases. Propensity score matching was used to account for selection bias. Adherence to and persistence with the index GLP‐1RA, and switching and augmentation patterns were assessed during the 6‐month post‐index period.ResultsMean adherence for the matched cohorts was significantly higher for dulaglutide than for exenatide once weekly (0.72 vs 0.61; P < .0001) and liraglutide (0.71 vs 0.67; P < .0001). The percentage of patients achieving PDC ≥ 0.80 was significantly higher for dulaglutide compared with exenatide once weekly (54.2% vs 37.9%; P < .0001) and liraglutide (53.5% vs 44.3%; P < .0001). The mean (standard deviation) days on treatment for all matched patients was significantly higher for patients in the dulaglutide cohort compared with those in the exenatide once‐weekly (148.4 [55.4] vs 123.6 [61.6]; P < .0001) and liraglutide cohorts (146.0 [56.9] vs 137.4 [60.1]; P < .0001). A significantly lower proportion of patients on dulaglutide discontinued treatment compared with those on exenatide once weekly (26.2% vs 48.4%; P < .0001) and those on liraglutide (28.0% vs 35.6%; P < .0001).ConclusionsDulaglutide initiators had significantly higher adherence, were more persistent, and had lower discontinuation rates compared with initiators of exenatide once weekly or liraglutide during the 6‐month follow‐up period.

Real-world comparison of treatment patterns and effectiveness of albiglutide and liraglutide

“…In that study, the odds ratio for adherence to albiglutide compared with dulaglutide was 0.63 (95% CI: 0.55-0.73), while it was 0.65 (95% CI: 0.49-0.71) for liraglutide compared with dulaglutide [18]. However, there are at least three important differences between the study by Alatorre et al [18] and the present study: first, the main focus of the study by Alatorre et al was on dulaglutide, exenatide q.w. and liraglutide, whereas the focus of the present study was on albiglutide and liraglutide because, at the time our study was conducted, the only GLP-1 receptor agonists that were tier 2 co-preferred with the same copay were albiglutide and liraglutide.…”

“…cohort had slightly greater adherence compared with the liraglutide cohort (mean PDC 0.68 for exenatide q.w. vs 0.67 for liraglutide) [ [18]. In that study, the odds ratio for adherence to albiglutide compared with dulaglutide was 0.63 (95% CI: 0.55-0.73), while it was 0.65 (95% CI: 0.49-0.71) for liraglutide compared with dulaglutide [18].…”

“…A recent meta-analysis also found that patients using albiglutide had the lowest treatment discontinuation rates of patients using all currently available GLP-1 receptor agonists [28]. However, Alatorre et al [18] recently reported lower discontinuation rates for patients using dulaglutide over a 6-month postindex period compared with those using albiglutide, exenatide q.w. and liraglutide [18].…”

“…vs 0.67 for liraglutide) [ [18]. In that study, the odds ratio for adherence to albiglutide compared with dulaglutide was 0.63 (95% CI: 0.55-0.73), while it was 0.65 (95% CI: 0.49-0.71) for liraglutide compared with dulaglutide [18]. However, there are at least three important differences between the study by Alatorre et al [18] and the present study: first, the main focus of the study by Alatorre et al was on dulaglutide, exenatide q.w.…”

“…A more recent study indicated that adherence rates were lower, and discontinuation rates were higher for liraglutide, albiglutide and exenatide q.w. compared with dulaglutide [18]. However, to date, there are no comparative data for albiglutide versus other GLP-1 receptor agonists, such as liraglutide, in a real-world setting.…”