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

Abstract

Introduction: The glucagon-like peptide-1 receptor agonist (GLP-1 RA) class is evolving and expanding. This retrospective database study evaluated recent real-world treatment and dosing patterns of patients with type 2 diabetes (T2D) initiating GLP-1 RAs in Belgium (BE), France (FR), Germany (DE), Italy (IT), the Netherlands (NL), and Canada (CA).

Methods: Adult T2D patients initiating GLP-1 RA therapy (dulaglutide [DULA], exenatide twice daily [exBID], exenatide once weekly [exQW], liraglutide [LIRA], or lixisenatide [LIXI]) from 2015 to 2016 were identified using the IQVIA (IQVIA, Durham, NC, and Danbury, CT, USA) Real-World Data Adjudicated Pharmacy Claims. The therapy initiation date was termed the 'index date.' Eligible patients had ≥ 180 days pre-index and ≥ 360 days post-index. Persistence (until discontinuation or switch) was evaluated over the variable follow-up using Kaplan-Meier (KM) survival analysis. Average daily dose (ADD) was calculated until discontinuation or switch.

Results: A total of 34,649 DULA, 3616 exBID, 11,138 exQW, 48,317 LIRA, and 2,204 LIXI patients were included in the analysis (34.9-63.2% female; median age range 53-62 years; median follow-up 16-30 months). Proportion persistent at 1-year post-index was 36.8-67.2% for DULA, 5.9-44.4% for exBID, 24.7-44.2% for exQW, 22.2-57.5% for LIRA, and 15.5-40.0% for LIXI. Median time persistent (days) was 245-381 for DULA, 62-243 for exBID, 121-319 for exQW, 103-507 for LIRA, and 99-203 for LIXI. Mean ADD was 13.21-20.43 µg for exBID, 1.44-1.68 mg for LIRA, and 19.88-20.54 µg for LIXI. Mean average weekly dose (AWD) ranged from 2.03 to 2.14 mg for exQW. Mean AWD for DULA was 1.25 mg in Canada and ranged from 1.43 to 1.53 mg in the other countries.

Conclusion: Across six countries, persistence was highest among DULA patients and generally lowest among exBID patients. ADD/AWD for all GLP-1 RAs was in line with the recommended label. Longer-term data would be useful to obtain a better understanding of GLP-1 RA treatment patterns over time.

Funding: Eli Lilly and Company, Indianapolis, IN, USA.

Keywords: Dulaglutide; Exenatide BID; Exenatide QW; Glucagon-like peptide-1 receptor agonists (GLP-1 RAs); Liraglutide; Lixisenatide; Persistence; Type 2 diabetes.

Figures

Fig. 1

Persistence at 1 year post-index. As an example, 36.8% of dulaglutide patients in Belgium were persistent at 1 year. BE Belgium, CA Canada, DULA dulaglutide, exBID exenatide twice daily, exQW exenatide once weekly, FR France, DE Germany, IT Italy, LIRA liraglutide, LIXI lixisenatide, NL Netherlands

Fig. 2

Kaplan–Meier analyses for time persistent over the variable follow-up: a Belgium, b France, c Germany, d Italy, e Netherlands, f Canada

Fig. 3

Median persistence over the variable follow-up. As an example, 50% of dulaglutide patients in Belgium were persistent at 245 days post-index. BE Belgium, CA Canada, CI confidence intervals, DULA dulaglutide, exBID exenatide twice daily, exQW exenatide once weekly, FR France, DE Germany, IT Italy, LIRA liraglutide, LIXI lixisenatide, NL Netherlands. *More than half of the dulaglutide patients in the Netherlands were still persisting with therapy at the end of the variable follow-up