Utilization Patterns of Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus in Italy: A Retrospective Cohort Study

Abstract

IntroductionReal-world evidence on glucagon-like peptide-1 receptor agonist (GLP-1 RAs) usage is emerging in different European countries but is lacking in Italy. This retrospective cohort study aimed to describe the real-world drug utilization patterns in patients initiating GLP-1 RAs for treating T2DM in Italy.MethodsAdults aged ≥ 20 years and with ≥ 1 oral antidiabetic drug (alone or in combination with insulin) other than GLP-1 RAs in the 6 months prior to initiating exenatide twice daily (exBID), exenatide once weekly (exQW), dulaglutide once weekly (DULA), liraglutide once daily (LIRA) or lixisenatide once daily (LIXI) between March and July 2016 were retrospectively identified in the Italian IMS LifeLink™ longitudinal prescriptions database (retail pharmacy data). Patients with ≥ 6-month follow-up (defined as evidence of any prescription activity) were included. Proportions of patients who remained persistent (continued treatment until discontinuation/switch) in the first 6 months and of those who discontinued or switched to a different GLP-1 RA over the entire follow-up were recorded. For each treatment, the average daily/weekly dosage (ADD/AWD) while persistent during the available follow-up was calculated.ResultsWe identified 7319 patients: 92 exBID, 970 exQW, 3368 DULA, 2573 LIRA and 316 LIXI. Across treatments, 89% patients were ≥ 50 years old, 54% were males, and the median follow-up duration ranged between 8.1 and 8.7 months. At 6 months, 35% exBID, 47% exQW, 62% DULA, 50% LIRA and 40% LIXI patients remained persistent. Over the entire follow-up, median persistence days varied from 73 (exBID) to > 300 days (DULA). The mean ± SD ADD/AWD was exBID: 17.7 ± 2.1 µg/day; exQW: 2.1 ± 0.1 mg/week; DULA: 1.5 ± 0.2 mg/week; LIRA: 1.5 ± 0.2 mg/day; LIXI: 21.0 ± 5.5 µg/day.ConclusionsThis real-world analysis suggests differences exist in persistence between patients treated with various GLP-1 RAs. Among the investigated treatments, patients prescribed exBID recorded the lowest and those prescribed DULA the highest persistence with therapy.FundingEli Lilly and Co., Indianapolis, IN, USA.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0396-2) contains supplementary material, which is available to authorized users.

Real-world impact on monthly glucose-lowering medication cost, HbA1c, weight, and polytherapy after initiating a GLP-1 receptor agonist

“…6,7 Literature suggests patients are more likely to adhere to injectable medications administered weekly rather than daily. [8][9][10][11] Clinical outcomes of HbA 1c reduction and weight loss seen in the present study were similar or better than those demonstrated in clinical trials that led to the approval of GLP-1 receptor agonists. The LEAD trials for liraglutide found 1.0%-1.5% reductions in HbA 1c and weight loss varied from 0.2-3.2 kg.…”

GLP-1 RA Treatment and Dosing Patterns Among Type 2 Diabetes Patients in Six Countries: A Retrospective Analysis of Pharmacy Claims Data

“…A retrospective cohort analysis was conducted using IQVIA’s Real-World Data (RWD) Adjudicated Pharmacy Claims in Belgium, France, Germany, Italy, the Netherlands, and Canada. Data from these European countries were utilized in prior analyses by the authors, and these countries were selected to provide a broad representation of several countries in Europe [ 35 , 37 , 39 – 41 ]. The current analysis follows previously published methods [ 35 , 40 ].…”

“…This study is an update of prior multi-country European analyses from the authors, incorporating more recent data and, specifically, the inclusion of patients treated with dulaglutide [ 35 , 40 ]. Recent analyses have also been completed by the authors in Italy and Germany, although with varied selection windows and follow-up periods [ 37 , 39 ].…”

Comparative effectiveness of exenatide once‐weekly versus liraglutide in routine clinical practice: A retrospective multicentre study and meta‐analysis of observational studies

“…After excluding those not reporting poolable data for any of the three elected outcome measures and adding the results of the present study, we included in the meta-analysis 3 studies 13,14 reporting the change in HbA1c (6035 patients) and the change in body weight (9384 patients), and 8 studies [15][16][17][18][19][20][21] reporting discontinuation rates (110 232 patients). Follow-up duration was 6 months in 5 studies 14,16,17,20,21 and 12 months in the others. 13,15,18,19 Altogether, there was no difference between liraglutide and ExeOW for the change in HbA1c [0.01%; 95% confidence interval (CI) -0.08; 0.09; no heterogeneity, Figure 2B] or for the change in body weight (0.12 kg; 95% CI -0.26; 0.51; no heterogeneity, Figure 2C).…”