Drug uilization patterns in patients Initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for the treatment of type 2 diabetes (T2D) in Germany: A retrospective cohort study

Objectives:

To better understand real-world persistence and treatment modifications in patients initiating GLP-1 RAs for treating T2D in Germany.

Methods:

Adults (≥18 years) with ≥1 oral antidiabetic treatment within 6 months prior to initiating their first GLP-1 RA therapy (index therapy) between February 1, 2015 and January 31, 2016, were retrospectively identified in the German longitudinal prescriptions (LRx) database (retail pharmacy data). For all patients with continuous prescription information ≥12-months, age, gender and median follow-up time were described. Proportions of patients who remained persistent with index therapy (time to discontinuation/switch) and average daily/weekly prescription doses (ADD/AWD) of index therapy were calculated.

Results:

Overall, 13,417 patients were identified: 8 albiglutide (small number, not subsequently considered), 1,187 exenatide twice daily (exBID), 1,222 exenatide once weekly (exQW), 4,571 dulaglutide (DULA), and 6,429 liraglutide (LIRA). Across treatments, mean ± SD age was 57.7 ± 11.1 years, 37% males, 37% females and gender information missing for 25% of patients. The median follow-up duration ranged between 20.3 and 21.8 months. At 12 months, 27% exBID, 35% exQW, 51% DULA, and 48% LIRA treated patients remained persistent. Mean ± SD ADD/AWD was exBID: 16.91 ± 0.95 mg/day; exQW: 2.0 ± 0.05 mg/week; DULA: 1.42 ± 0.03 mg/week; and LIRA: 1.41 ± 0.10 mg/day.

Conclusions:

Patients prescribed exBID recorded the lowest, and those prescribed LIRA and DULA the highest persistence with therapy in the first 12 months from treatment initiation. ADD/AWD for DULA, exQW and exBID were in line with the recommended dose for combination therapy; LIRA ADD suggests some patients are using the 1.8 mg dose.