<p>Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States</p>

Abstract

Aim: To assess adherence and discontinuation of injectable glucagon-like peptide-1 receptor agonists (GLP-1 RA) at 12 and 24 months among adult type 2 diabetes mellitus (T2DM) patients in the United States initiating GLP-1 RA using the administrative claims-based database, Optum Clinformatics ® Data Mart 7.1. Methods: A retrospective study was conducted from 01/2009 to 12/2017. Patients were required to be continuously enrolled for 12 months prior to their first GLP-1 RA prescription. Proportion of days covered (PDC) from prescription claims ≥0.80 defined adherence. Discontinuation was defined as a ≥90-day gap from the last date of GLP-1 RA supply to the first date of subsequent prescription claim. Results: A total of 4791 T2DM patients had ≥1 and 3907 had ≥2 GLP-1 RA prescription claims. 50.9% and 47.4% of patients were adherent at 12 and 24 months, respectively. Adherence was significantly higher among patients on weekly vs daily doses (p<0.001). Median time to discontinuation was 13 months. The discontinuation rate was 47.7% and 70.1% at 12 and 24 months, respectively, with differences at 24 months for age and dosing frequency (p<0.001 for both). Conclusion: Over half of T2DM patients initiating GLP-1 RA were non-adherent and the majority (70.1%) discontinued therapy by 24 months. Reasons for non-adherence and discontinuation merit further research.

Basal weekly insulins: the way of the future!

“…For example, a population-based analysis in the UK estimated a median delay to insulin initiation of 4.9 years and 4.2 years for patients with HbA 1c levels of ≥8.0% and ≥9.0%, respectively [33]. Clinical inertia on the part of either clinicians or their patients has been attributed to concerns related to hypoglycemia and weight gain, fear of injections, and anticipation of problems with treatment adherence and a reduced quality of life [31,32,[34][35][36][37][38][39][40][41]. Technological advances (e.g., in formulations and devices) have addressed some of these concerns, and many can be managed through education and support [32,42]; as such, these concerns may often be unwarranted.…”

“…If a basal insulin could be injected just once weekly, it is reasonable to predict that this would reduce clinical inertia, increase treatment adherence, and improve patients' quality of life, provided that the risk of hypoglycemia remains low. It is reasonable to extrapolate such assumption from the comparisons of once-weekly GLP-1 RAs with once-daily GLP-1 RAs that are encouraging in this regard [38][39][40][41].…”

“…Injection-experienced patients have expressed a significant preference for a hypothetical GLP-1 RA using a once-weekly, rather than a once-daily, frequency of administration (odds ratio 2.26; 95% CI 2.13 to 2.39; p < 0.001) [39]. Other observational studies [38,41] support these findings and also show that persistence is improved by once-weekly compared with once-daily GLP-1 RA injections [41,88]. The same preference may also conceivably be expected for once-weekly over once-daily basal insulins to facilitate and improve basal insulin replacement.…”

Glucagon-Like Peptide 1 Receptor Agonist Usage in Type 2 Diabetes in Primary Care for the UK and Beyond: A Narrative Review

“…Real-world studies suggest that 12-month discontinuation rates for GLP-1 RA therapy vary Where data are conflicting or lacking, advice is provided that is based on expert opinion and experience in T2D management ADA American Diabetes Association between 29.5% and 47.7% [84,85]. These rates appear to be higher than those reported in clinical trials, for example, 22.6% of patients prematurely discontinued therapy during the 24-month trial period in the SUSTAIN 6 trial of semaglutide [37], and 27.6% of randomised patients prematurely discontinued albiglutide during the 25-month trial period in the HAR-MONY trial [86].…”

Treatment options following metformin in primary prevention populations with type 2 diabetes: which is the right road to take?

“…Although an oral preparation of semaglutide is available, GLP-1 RAs are mostly injectable therapies at the moment, and this might be a barrier in adherence and persistence to treatment for a number of patients [9]. Moreover, real-world data reveal high rates of treatment discontinuation (even as high as 47.7% at 12 months) among GLP-1 RAs recipients [10]. This might relate to the administration route or to gastrointestinal symptoms, such as nausea and vomiting, which however, wane over time in the majority of people treated with these agents.…”