The objective of this retrospective real-world observational study was to compare 1-year adherence and persistence among patients initiating GLP-1 receptor agonists (GLP-1RA), dulaglutide (DULA) vs. liraglutide (LIRA) or DULA vs. exenatide QW (EQW) in the U.S., using claims data between November 2014 and May 2016 (index date=earliest GLP-1RA fill date) from the HealthCore Integrated Research Database (HIRD®).
Patients ≥18 years old, with T2DM, no claim for index drug in the 6 months pre-index period, and continuous enrollment 6 months pre- and 1-year post-index were included. DULA users were propensity-matched 1:1 to LIRA (2,427 pairs) or EQW (1,8pairs) users. Matched cohorts were balanced in baseline characteristics and the mean age was 54 years with around 52% males.
The key adherence and persistence outcomes are included in the table. At 1-year, DULA users were more likely to be adherent [Proportion of Days Covered (PDC)≥80%] than LIRA (odds ratio [OR]=1.76, 95% CI=[1.56, 1.99]) or EQW users (OR=2.31, 95% CI=[2.00, 2.66]). Cox regression showed that DULA users were less likely to discontinue therapy than LIRA (hazard ratio [HR]=0.75, 95% CI=[0.69, 0.81]) or EQW users (HR=0.58, 95% CI=[0.53, 0.63]).
At 1-year follow-up, patients initiating DULA had higher medication adherence, and were more persistent to their treatment compared to patients initiating either LIRA or EQW.
Table: 1-Year Follow-up Adherence and Persistence Outcomes Among GLP-1 RA Initiators
Matched DULA vs. LIRA Cohorts | Matched DULA vs. EQW1 Cohorts | |||||
DULA | LIRA | p-value2 | DULA | EQW1 | p-value2 | |
N=2,427 | N=2,427 | N=1,808 | N=1,808 | |||
Proportion of Days Covered (PDC), mean (SD) in % | 67.3% (32.1) | 59.5% (32.6) | <0.001 | 66.8% (32.2) | 51.3% (34.6) | <0.001 |
Adherence (PDC ≥ 80%), % | 51.2% | 38.2% | <0.001 | 50.7% | 31.9% | <0.001 |
Patients who discontinued therapy, % | 51.1% | 62.0% | <0.001 | 51.1% | 70.9% | <0.001 |
Persistence3, mean (SD) days | 251.9 (135.7) | 217.3 (143.0) | <0.001 | 250.5 (136.8) | 191.6 (139.3) | <0.001 |
Matched DULA vs. LIRA Cohorts | Matched DULA vs. EQW1 Cohorts | |||||
DULA | LIRA | p-value2 | DULA | EQW1 | p-value2 | |
N=2,427 | N=2,427 | N=1,808 | N=1,808 | |||
Proportion of Days Covered (PDC), mean (SD) in % | 67.3% (32.1) | 59.5% (32.6) | <0.001 | 66.8% (32.2) | 51.3% (34.6) | <0.001 |
Adherence (PDC ≥ 80%), % | 51.2% | 38.2% | <0.001 | 50.7% | 31.9% | <0.001 |
Patients who discontinued therapy, % | 51.1% | 62.0% | <0.001 | 51.1% | 70.9% | <0.001 |
Persistence3, mean (SD) days | 251.9 (135.7) | 217.3 (143.0) | <0.001 | 250.5 (136.8) | 191.6 (139.3) | <0.001 |
1The study included only exenatide QW pen users.
2P-values for categorical variables were obtained using Chi-square tests; p-values for continuous variables were obtained using Wilcoxon rank sum tests.
3The number of days of continuous index GLP-1 RA therapy since initiation, allowing for a maximum gap (between fills) of 45 days. Patients who were censored at the end of the 1-year follow-up period were included.
R. Mody: Employee; Self; Eli Lilly and Company. Q. Huang: Other Relationship; Self; Eli Lilly and Company. M. Yu: Employee; Self; Eli Lilly and Company. R. Zhao: Other Relationship; Self; Eli Lilly and Company. H. Patel: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. M. Grabner: Employee; Self; HealthCore, Inc. L. Fernandez Lando: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.