Background: GLP-1 RAs are an incretin-based, injectable, therapeutic option for the treatment of T2D. However, there are limited data related to patients’ adherence to, or discontinuation of, GLP-1 RA therapy in the real-world.

Methods: Using the Optum Research Database (2010-2016), we conducted a retrospective cohort study of U.S. T2D patients ≥ 18 years initiating GLP-1 RAs as monotherapy or as dual therapy with metformin to evaluate GLP-1 RA adherence and discontinuation. GLP-1 RA adherence was assessed using the proportion of days covered (PDC) among all GLP-1 RA initiators with two or more prescription fills. Discontinuation was defined as any GLP-1 RA therapy gap >90 days after end of days of supply from medication fill during follow-up. Multivariable logistic regression was used to evaluate factors associated with non-adherence and discontinuation.

Results: Of 4,791 patients included, 42% were female and median age was 56 years. The proportion of patients characterized as non-adherent (PDC <80%) was 49.1% within 1 year. The proportion of patients who discontinued therapy was 47.7% within 1 year. Factors associated with poor adherence/discontinuation within 1 year included male sex, older age, Southern geographic region, and Medicare insurance.

Conclusion: A substantial proportion of U.S. T2D patients are non-adherent to GLP-1 RA therapy and nearly half of patients discontinue GLP-1 RA therapy within a year. Further investigation on the impact of adherence on real-world effectiveness, including weight loss and HbA1c, is warranted.


T. Weiss: Employee; Self; Merck & Co., Inc. K. Iglay: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. R.D. Carr: Employee; Self; Merck & Co., Inc. Speaker's Bureau; Spouse/Partner; Eli Lilly and Company, Merck & Co., Inc. A.P. Mishra: None. L. Yang: Employee; Self; Bristol-Myers Squibb Company, Merck & Co., Inc. S. Rajpathak: None.

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