medwireNews: Dulaglutide is associated with better treatment persistence and lower rates of treatment modification versus other glucagon-like peptide (GLP)‑1 receptor agonists in people with type 2 diabetes, suggests a study of Swedish health registries.
The study included data from 17,361 adults with type 2 diabetes who initiated, for the first time, treatment with dulaglutide (n=3390), liraglutide (n=12,461), exenatide (n=713), or lixisenatide (n=797) between 2015 and 2017.
Anders Toll (Eli Lilly, Solna, Sweden) and co-authors report that during the 2.5 years after treatment initiation, individuals who started on dulaglutide were more likely to remain on treatment than those who started on exenatide, liraglutide, or lixisenatide.
When non-persistence was defined as a gap of 45 days or more between the end of one prescription supply and the date of the next claim, people on dulaglutide had the highest percentage of persistence 1 year after treatment initiation (85.0%) compared with those on liraglutide (75.5%), exenatide (69.4%), or lixisenatide (66.6%).
In an inverse probability of treatment weight (IPTW) analysis using propensity scores to account for confounding factors, treatment with exenatide, liraglutide, or lixisenatide was associated with a significantly higher risk for treatment discontinuation versus treatment with dulaglutide, at hazard ratios (HRs) of 2.1, 1.6, and 2.4, respectively.
A sensitivity analysis in which non-persistence was defined as a treatment gap of 60 days “did not impact the results more than minimally, including the relative results between drugs, compared with the 45-day gap analysis,” according to the authors.
They also found that after 1 year, the proportion of individuals with treatment modifications was significantly lower in the dulaglutide group (39.2%) versus the exenatide (55.5%), liraglutide (44.4%), and lixisenatide (63.6%) groups. In the IPTW analysis, the HRs for treatment modification with exenatide, liraglutide, and lixisenatide versus dulaglutide were 1.5, 1.2, and 2.0, respectively.
People who continued the same initial treatment throughout the first year had greater reductions in glycated hemoglobin levels, and more consistent weight loss, over 1 year compared with individuals who had treatment modifications.
“Persistence of treatment is a critical determinant of clinical outcomes and thus an integral factor of patient-centric treatment for [type 2 diabetes]" writes the team in Diabetes, Obesity and Metabolism.
The researchers conclude that "[u]sing treatments shown to have long treatment persistence would likely help to achieve treatment goals.”
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