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Abstract
Aims:
To assess adherence to the UK’s National Institute for Health and Care Excellence (NICE) guidelines for initiating and continuing glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes (T2DM).
Research design and methods:
A retrospective cohort study of 7133 primary care patients ≥40 years with a first prescription for a GLP-1 receptor agonist following publication of NICE guideline/guidance. Patient characteristics and levels of clinical monitoring were assessed using descriptive analyses.
Main outcome measures:
Main outcomes were the proportion of patients initiating GLP-1 receptor agonists as part of NICE-recommended dual- or triple-therapy regimens; the proportions meeting NICE triple therapy initiation criteria (glycosylated hemoglobin [HbA1c] ≥7.5% and body mass index [BMI] ≥35 kg/m2) and the proportions continuing GLP-1 receptor agonist at 6 months according to NICE recommendations.
Results:
Mean age at initiating GLP-1 receptor agonists was 58.2 years (SD 9.4), BMI 38.4 kg/m2 (SD 6.8) and HbA1c 9.2% (SD 3.2%). Overall, only 25% of patients initiated GLP-1 receptor agonists as part of a NICE-recommended regimen. Of patients initiated on a recommended triple-therapy regimen, 50% (646/1284) fulfilled both NICE HbA1c and BMI initiation criteria. Approximately 18% (32/174) of patients continuing NICE-recommended dual therapy at 6 months achieved a 1% reduction in HbA1c and 6.4% (33/515) continuing with NICE-recommended triple therapy achieved NICE’s target reductions for both HbA1c and body weight. About 8% of patients continuing exenatide as triple therapy (N = 243) achieved both targets.
Conclusions:
Adherence to NICE guidance for initiating and continuing GLP-1 receptor agonists is low. However, lack of data on ethnicity (for assessing NICE’s BMI criteria) and on contraindications and/or hypersensitivity to other diabetes medication in the treatment pathway have limited our ability to fully assess adherence to GLP-1 prescribing. Further research is warranted to better understand general practitioners’ prescribing decisions given the cost of prescribing GLP-1 receptor agonists.
Transparency
Declaration of funding
This research was funded by Merck Sharp & Dohme Ltd. K.J. conceived the study, co-designed the study and contributed to the drafting and the revision of the manuscript. K.D. participated in its design and contributed to the drafting and revision of the manuscript. P.L. participated in its design and contributed to the revision of the manuscript. T.M.-T. co-designed the study, developed the data management programs, performed the statistical analysis and drafted and revised the manuscript.
Declaration of financial/other relationships
K.J. and P.L. have disclosed that they were previously employees of Merck Sharp & Dohme Ltd. K.D. has disclosed that she is currently employed by Merck Sharp & Dohme Ltd. T.M.-T. has disclosed that she was paid to undertake this study on behalf of Merck Sharp & Dohme Ltd and has no other competing interests.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors were supported by Jenny Grice and Susan Bromley, medical writers funded by MSD and CPRD respectively.
Previous presentation: International Society for Pharmacoeconomics and Outcomes Research (ISPOR), 8–12 November 2014, Amsterdam RAI, Amsterdam, Netherlands.