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Abstract
Objective: This retrospective database analysis complements previous research to understand treatment patterns for German patients newly-initiating or switching to subsequent GLP-1 RAs.
Methods: Adult patients (≥18 years) initiating GLP-1 RA (Cohort 1 [C1]) or switching from a previous GLP-1 RA (Cohort 2 [C2]) to exenatide twice-daily (exBID), exenatide once-weekly (exQW), dulaglutide (DULA), or liraglutide (LIRA) were included in this analysis using IQVIA LRx from January 1, 2014–March 31, 2017. Patients were required to have ≥1 oral anti-hyperglycemic prescription during the 6-month pre-index period and ≥12 months follow-up. Persistence and treatment modifications were assessed within and beyond 12 months follow-up. Average daily/weekly dosage (ADD/AWD) was calculated during persistence.
Results: C1 included 13,417 patients, while C2 included 4,264 patients. Mean ± standard deviation (SD) age was similar (57.7 ± 11.1 years [C1], 58.9 ± 10.1 years [C2]). Most patients using DULA in C2 had switched from LIRA (56.6%). For C1, mean ADD for LIRA was 1.41 ± 0.10 mg, slightly higher in C2, and increased over time. ADD for exBID was 16.9 ± 1.0 mcg, slightly greater in C2. AWD was 2.00 ± 0.05 mg for exQW users and 1.42 ± 0.03 mg for DULA users in C1, similar to C2. For C1, 27.0% exBID, 35.3% exQW, 50.9% DULA, and 48.1% LIRA users remained persistent at 12 months. Patients using DULA had a higher probability of remaining persistent over time (Kaplan-Meier) for both cohorts.
Conclusions: Patients using DULA had the highest probability of remaining persistent over time, followed by LIRA. ADD/AWD for DULA, exQW, and exBID were aligned with the recommended combination therapy dose; LIRA ADD suggests some patients use the 1.8 mg dose.
Transparency
Declaration of funding
Sponsorship for this study and article processing charges were funded by Eli Lilly and Company, Indianapolis, IN.
Declaration of financial/other interests
Trulicity® (dulaglutide) is a registered trademark owned and licensed by Eli Lilly and Company, its subsidiaries, or affiliates. IQVIA received consulting fees from Eli Lilly and company for the conduct of this study. Kirsi Norrbacka is an employee and a shareholder of Eli Lilly and Company. Thorsten Otto is an employee of Eli Lilly and Company. Heike Jung is an employee and shareholder of Eli Lilly and Company. Jeremie Lebrec is an employee of Eli Lilly and Company. Hartmut Richter and Melissa Myland are employees of IQVIA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. CMRO peer reviewers on this manuscript have no relevant financial relationships to disclose.
Acknowledgments
The authors thank Sarah Jenner, employee of IQVIA, who has been involved in the study set up and protocol writing.
