Using Exenatide Twice Daily or Insulin in Clinical Practice: Results from CHOICE

Mathieu, Chantal; Östenson, Claes‐Göran; Matthaei, S.; Reaney, Matthew; Krarup, Thure; Guerci, Bruno; Kiljański, Jacek; Salaun-Martin, C.; Sapin, Hélène; Theodorakis, Michael J.

doi:10.1007/s13300-013-0037-8

Cited by 11 publications

(17 citation statements)

References 29 publications

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“…However, high levels of missing data were observed for PRO measures throughout the study compared with those observed for clinical outcomes [22]. There are a number of potential explanations for this.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the study recruited patients initiating either exenatide BID or their first insulin regimen in routine clinical practice. Baseline patient characteristics [ 21 ] and clinical outcomes, healthcare resource use, and costs during the 24 months after initiation of injectable therapy in CHOICE have been reported elsewhere [ 22 - 24 ]. Understanding PROs following injectable therapy initiation will provide additional insight from the patient’s perspective that, together with clinical data, will help patients and clinicians to make better informed treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

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Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study

Reaney

Mathieu

Östenson

et al. 2013

Health Qual Life Outcomes

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BackgroundImprovements in the clinical condition of patients with type 2 diabetes are often accompanied by improvements in health-related quality of life and other patient-reported outcomes (PROs), but data assessing injectable treatment initiation from the patient’s perspective in routine clinical practice are lacking. We examined PROs in patients initiating injectable treatment in the CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) study.MethodsCHOICE was a 24-month, prospective observational study conducted in six European countries. Patients initiated exenatide twice daily (BID) or insulin based on a physician’s clinical judgement. Clinical and PRO data were collected at baseline (injectable therapy initiation) and after approximately 3, 6, 12, 18 and 24 months. The two treatment cohorts had different baseline characteristics; therefore, no statistical comparisons of endpoints between main cohorts were conducted.ResultsThere were 2388 patients eligible for analysis (exenatide BID cohort, n = 1114; insulin cohort, n = 1274). Mean positive changes in Impact of Weight on Quality of Life-Lite (IWQOL-Lite) total score and EuroQoL5-Dimension (EQ-5D) index and visual analogue scale (VAS) scores were observed in both cohorts with most changes observed during the first 6 months after injectable therapy initiation. Patients who experienced weight loss (≥1 kg) at 24 months appeared to have higher mean improvements in IWQOL-Lite total score than did patients with weight gain or no weight change. Patients who met the composite clinical endpoint of glycated haemoglobin (HbA1c) <7.0%, no weight gain (≤1 kg) and no hypoglycaemia generally experienced higher mean improvements in EQ-5D index and VAS scores (compared with patients who did not meet this endpoint) and Diabetes Health Profile-18 scores (versus the main cohorts). High levels of missing data were observed for all PRO measures in both cohorts compared with those for clinical outcomes.ConclusionsThese data from a clinical practice study support those from clinical trials, suggesting that PROs are not adversely affected, and may be improved, by injectable therapy initiation. PRO data may aid appropriate treatment selection for individual patients.Trial registrationClinicalTrials.gov, NCT00635492

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study

Reaney

Mathieu

Östenson

et al. 2013

Health Qual Life Outcomes

Self Cite

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“…At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort 21. The most common reason for discontinuing the initial injectable therapy was inadequate response (15.3% of the exenatide bid cohort and 6.8% of the insulin cohort); adverse events were the reason for discontinuing initial injectable therapy for 8.2% of the exenatide bid cohort and 0.9% of the insulin cohort 21.…”

Section: Resultsmentioning

confidence: 99%

“…The most common reason for discontinuing the initial injectable therapy was inadequate response (15.3% of the exenatide bid cohort and 6.8% of the insulin cohort); adverse events were the reason for discontinuing initial injectable therapy for 8.2% of the exenatide bid cohort and 0.9% of the insulin cohort 21. The clinical results of CHOICE and additional details regarding the reasons for discontinuation of initial injectable therapy are reported elsewhere 21…”

Section: Resultsmentioning

confidence: 99%

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Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

Kiiskinen¹,

Matthaei²,

Reaney³

et al. 2013

CEOR

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PurposeCHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study.MethodsCHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin) and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices.ResultsA total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both), but mean weight was reduced in the exenatide bid cohort (P < 0.001) and increased in the insulin cohort (P < 0.001) by 24 months. Across all countries, total per patient health care costs for the 24 months post baseline were €3997.9 in the exenatide bid cohort and €3265.5 in the insulin cohort (€1791.9 versus €2465.5 due to costs other than those of injectable therapy). When baseline direct cost and patients’ and disease characteristics were controlled for, mean direct costs differed by country (P < 0.0001), irrespective of treatment initiated, and the mean cost difference between treatments varied by country (P < 0.0001).ConclusionMuch of the higher mean cost of exenatide bid, compared with insulin, therapy was compensated for by lower mean costs of other health service utilization. Costs associated with exenatide bid or insulin initiation varied across countries, highlighting the need to avoid generalization of resource use and cost implications of a particular therapy when estimated in specific country settings.

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Effects of Exenatide in a Morbidly Obese Patient with Type 2 Diabetes

Kishimoto

Noda

2014

Diabetes Ther

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IntroductionThe effect of exenatide in weight loss has been reported. Presented here is a case of a morbidly obese patient with type 2 diabetes using exenatide who dramatically lost her body weight in a year and experienced improved glycemic control.Case reportExenatide therapy was initiated for a 59-year-old morbidly obese Japanese woman with type 2 diabetes. To examine the effects of the exenatide treatment, continuous glucose monitoring was performed, and blood was drawn at 0, 30, 60, 120, and 180 min after breakfast to measure insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic peptide (GIP) levels. After 1 year of exenatide therapy, the patient lost 37.5 kg, her glycemic control improved, and her insulin sensitivity recovered. The patient’s levels of insulin, glucagon, active GLP-1, and total GIP also decreased after 1 year of exenatide treatment.ConclusionThe exenatide treatment was effective for reducing body weight and improving glycemic control. After 1 year of exenatide treatment, decreased glucagon, active GLP-1, and total GIP levels were observed following a meal, suggesting that exenatide might affect these hormonal reactions.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0050-6) contains supplementary material, which is available to authorized users.

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Using Exenatide Twice Daily or Insulin in Clinical Practice: Results from CHOICE

Cited by 11 publications

References 29 publications

Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study

Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study

Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

Effects of Exenatide in a Morbidly Obese Patient with Type 2 Diabetes

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