Evaluating preferences for profiles of GLP-1 receptor agonists among injection-naïve type 2 diabetes patients in the UK

Abstract

ObjectiveTo use a discrete choice experiment (DCE) to evaluate preferences for the actual treatment features and overall profiles of two injectable glucagon-like peptide-1 receptor agonists (dulaglutide and liraglutide) among patients with type 2 diabetes mellitus (T2DM) in the UK.MethodsIn-person interviews were conducted in the UK to administer a DCE to patients with self-reported T2DM, naïve to treatment with injectable medications. The DCE examined six attributes of T2DM treatment each described by two levels: “dosing frequency,” “hemoglobin A1c change,” “weight change,” “type of delivery system,” “frequency of nausea,” and “frequency of hypoglycemia.” Part-worth utilities were estimated using random effects logit models and were used to calculate relative importance (RI) values for each attribute. A chi-square test was used to determine differences in preferences for dulaglutide versus liraglutide profiles.ResultsA total of 243 participants [mean age: 60.5 (standard deviation 10.9) years; 76.1% male; mean body mass index: 29.8 (standard deviation 5.4) kg/m2] completed the study. RI values for the attributes in rank order were: “dosing frequency” (41.6%), “type of delivery system” (35.5%), “frequency of nausea” (10.4%), “weight change” (5.9%), “hemoglobin A1c change” (3.6%), and “frequency of hypoglycemia” (3.0%). Significantly more participants preferred the dulaglutide profile (83.1%) compared with the liraglutide profile (16.9%; P<0.0001).ConclusionThis study elicited patients’ preferences for attributes and levels representing the actual characteristics of two specific glucagon-like peptide-1 medications. In this context, dosing frequency and type of delivery system were most important, accounting for over 75% of the RI. While previous studies have identified efficacy as highly important in T2DM medication decisions, this study suggests that when differences in efficacy between medications are small, other treatment features (eg, dosing frequency and delivery system) are of much greater importance to patients.

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

“…Efficacy was found to be less influential in other GLP-1RA DCE studies [27, 28] versus the current study. However, efficacy was defined differently in these other studies (i.e., achieving HbA1c <7%) [27, 28], and the difference between the levels was very small (e.g., 67.9% vs. 68.3% [27] and 69.1% vs. 71.4% [28] of patients achieving HbA1c goal of <7%), thereby reducing its importance as an influential attribute.…”

“…However, efficacy was defined differently in these other studies (i.e., achieving HbA1c <7%) [27, 28], and the difference between the levels was very small (e.g., 67.9% vs. 68.3% [27] and 69.1% vs. 71.4% [28] of patients achieving HbA1c goal of <7%), thereby reducing its importance as an influential attribute. Even in this study, efficacy played a less prominent role overall when examining preferences for two different full profiles.…”

“…Furthermore, liraglutide QD is the leading daily treatment for T2DM, and exenatide QW is the first once-weekly T2DM treatment. Nevertheless, other published studies have taken a similar approach comparing two specific treatments and have shown that results from general designs are often different than results for more specific designs involving comparisons of specific treatments [27, 28]. Additionally, subjects were asked to consider the overall tolerability profile of the treatments based on the most commonly occurring side effects, though the influence of specific side effects on preferences may have varied.…”

Evolution of glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes

“…Характеристики шприц-ручки дулаглутида, получившие наивысшие оценки, были связаны с наличием предварительно при-крепленной иглы, автоматическим введением дозы, что устраняло необходимость дополнительных манипу-ляций с иглой, пациент не вводит себе иглу под кожу, игла скрыта от глаз пациента [57]. В экспериментальном исследовании дискретного выбора, в котором исполь-зовались гипотетические препараты, смоделированные по типу дулаглутида и лираглутида, пациенты с СД2 без предшествующего опыта применения инъекционных препаратов отдавали явное предпочтение однодозовым шприц-ручкам перед многодозовыми [58]. Тип средства для введения препарата пациенты оценивали как второй по важности аспект терапии после частоты дозирования.…”

“…Как отмечалось выше, пациенты в эксперименте с дискретным выбором оце-нивали частоту дозирования как наиболее важный аспект АР ГПП-1, отдавая явное предпочтение препа-ратам с введением 1 р/нед [58]. Менее частое введение также ассоциировано с лучшей приверженностью лече-нию, что продемонстрировано в исследованиях, в ко-торых приверженность терапии АР ГПП-1 длительного действия была выше, чем приверженность терапии АР ГПП-1 короткого действия [59,60].…”