Introduction & Objective: The objective of this study is to elucidate the prescription order of GLP-1 receptor agonists (GLP-1RA) and predictors affecting their selection in Japanese type 2 diabetes (T2D) using real-world data.
Methods: The subjects were extracted from individuals with T2D attending our 4 hospitals (approximately 10,000/month in outpatient attendance) newly prescribed GLP-1RA between 2016 and 2019, excluding those initiated during hospitalization. Using clinical information databases, we examined patient backgrounds and changes over time in selection orders of GLP-1RA among antidiabetic drugs, as well as concurrent drugs. To identify predictors for GLP-1RA being the first or second choice, multiple regression analysis was performed with variables such as age, gender, prescription year, medical history, BMI, HbA1c, presence of chronic kidney disease (CKD), and insulin use as independent variables.
Results: We included 671 participants (259 females) with a median age [25-75 percentile] of 61.0 [50.0-72.0] years and BMI of 27.3 [23.8-31.6] kg/m2. Among GLP-1RA, 62.6% were dulaglutide, while 36.1% were liraglutide. GLP-1RA remained third new prescription from 2016 to 2019, with no changes over time. Switching from other medications accounted for 76.5% (1st: DPP4i, 2nd: rapid-acting insulin), while adding to current treatments constituted 23.5%. When prescribed as the third choice, the most common pre-prescribed combination was biguanide + insulin throughout the study period. The predictors for the early selection of GLP-1RA were older age, given the popularity of low-dose dulaglutide, and presence of CKD.
Conclusion: GLP-1RA was the third choice among antidiabetic drugs, with frequent switches from DPP4i or insulin. It was considered that older age or the presence of CKD were predictors for early selection of GLP-1RA. We will monitor for changes in predictors with introduction of semaglutide and tirzepatide.
Y. Suganuma: None. M. Ishiguro: None. T. Ohno: None. R. Nishimura: Speaker's Bureau; Abbott. Advisory Panel; Abbott Japan Co., Ltd. Speaker's Bureau; Boehringer-Ingelheim, Mitsubishi Tanabe Pharma Corporation, Kowa Company, Ltd., Medtronic, Sanofi, Taiho Pharmaceutical Co. Ltd., Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Eli Lilly and Company, Novo Nordisk A/S. Consultant; Terumo Corporation.
