Adherence, persistence, glycaemic control and costs among patients with type 2 diabetes initiating dulaglutide compared with liraglutide or exenatide once weekly at 12‐month follow‐up in a real‐world setting in the United States

Abstract

Aims To evaluate adherence, persistence, glycaemic control and costs at 12‐month follow‐up for patients initiating dulaglutide versus liraglutide or exenatide once weekly. Materials and methods The present retrospective observational claims study included patients with type 2 diabetes (T2D) and ≥ 1 pharmacy claim for dulaglutide, liraglutide or exenatide once weekly from the HealthCore Integrated Research Database. Adherence was defined as proportion of days covered ≥80%, and persistence was measured by time to discontinuation of index therapy. Change from baseline in glycated haemoglobin (HbA1c) concentration was assessed in a subset with pre‐ and post‐index HbA1c results. Propensity scores were used to match the cohorts. Results The baseline characteristics were balanced for the matched cohorts, dulaglutide versus liraglutide (n = 2471) and dulaglutide versus exenatide once weekly (n = 1891). Among those initiating dulaglutide there was a significantly higher proportion of adherent patients compared with the groups initiating liraglutide (51.2% vs. 38.2%; P < 0.001) and exenatide once weekly (50.7% vs. 31.9%; P < 0.001). At 12 months, 55% of patients in the dulaglutide group versus 43.8% in the liraglutide group (P < 0.001), and 54.9% in the dulaglutide versus 34.4% in the exenatide once‐weekly group (P < 0.001) were persistent. The dulaglutide group had a significantly greater reduction in HbA1c than the liraglutide group (−34.24 vs. −31.94 mmol/mol; P = 0.032), and a greater, but nonsignificant, reduction in HbA1c than the exenatide once‐weekly group (−34.46 vs. −31.94 mmol/mol; P = 0.056). The diabetes‐related total costs were not significantly different between the dulaglutide and the liraglutide group ($16,174 vs. $16,694; P = 0.184), and were significantly higher for dulaglutide than for exenatide once weekly ($15,768 vs. $14,615; P = 0.005). Conclusions Adherence and persistence are important considerations in patient‐centric treatment selection for patients with T2D. Higher adherence and persistence for dulaglutide compared with liraglutide or exenatide once weekly are relevant criteria when choosing glucagon‐like peptide‐1 receptor agonist treatment for patients with T2D.

Comparative Effectiveness of Dulaglutide Versus Iiraglutide in Asian type 2 Diabetes Patients: A Multi-Institutional Cohort Study and Meta-Analysis

“…Nevertheless, consistent with previous studies [6,9,27], we found a signi cantly larger HbA1c reduction with dulaglutide versus liraglutide. The favorable glycemic control of dulaglutide over liraglutide might be explained by better adherence owing to its once-weekly regimen [27] and its longlasting drug action attributable to the longer half-life [28]. And, our meta-analysis that incorporated all existing data (including the present study) has demonstrated that the use of dulaglutide versus liraglutide possessed a superior glycemic control over a 6-month or 12-month follow-up ( Fig.…”

“…Compared to these previous studies with certain limitations such as having a more homogeneous population [4][5][6] or a limited number of patients (i.e., 417 ~ 1,344 study subjects [4][5][6][9][10][11]), this present large real-world study of GLP-1RAs in Taiwan reveals the greater bene t of glycemic control using dulaglutide versus liraglutide over a follow-up of 3-12 months (Fig. 2).…”

“…However, the small number of study participants in the Japanese trial [5,6] and the selective and homogenous study populations in well-controlled trial settings [4][5][6] may limit the generalizability of study results to realworld diverse populations treated with GLP-1RAs. Our systematic review found that three real-world studies [9][10][11] have been conducted on the comparative effectiveness of dulaglutide versus liraglutide over a follow-up of 6 or 12 months in non-ethnically Chinese populations (Appendix Table 4), showing a greater glycemic reduction with dulaglutide versus liraglutide [9,11], except the Canadian study [10].…”

Enrolment criteria for diabetes cardiovascular outcome trials do not inform on generalizability to clinical practice: The case of glucagon‐like peptide‐1 receptor agonists

“…Observational studies, although unable to substitute for CVOTs, complement CVOT findings and can provide an estimate of true effectiveness in real‐world patients often not represented in CVOTs. Real‐world studies on the glycaemic and extra‐glycaemic effectiveness of GLP‐1RAs have confirmed findings from phase III RCTs, but there is still a paucity of cardiovascular real‐world studies . In a small study from the UK, the intensification of oral therapy by adding GLP‐1RAs was associated with a lower cardiovascular events rate than the intensification with insulin .…”

<p>Dulaglutide as an Add-on to Insulin in Type 2 Diabetes; Clinical Efficacy and Parameters Affecting the Response in Real-World Practice</p>

“…To the best of our knowledge, the present study is the first to determine the efficacy of the addition of dulaglutide to insulin therapy in a real-world setting. Only a few previous studies have demonstrated the efficacy of dulaglutide in a real-world setting, 17,19,25,26 but these studies mainly compared the efficacy of the combination of dulaglutide and other OADs.…”