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Retrospective Study of Adherence to Glucagon-like Peptide-1 Receptor Agonist Therapy in Patients with Type 2 Diabetes Mellitus in the United States

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Abstract

Introduction

Greater adherence to medications has been broadly demonstrated to be associated with improved clinical outcomes. However, there is limited real-world evidence on adherence to glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes mellitus (T2DM).

Methods

This retrospective cohort study used United States administrative claims data to compare adherence to GLP-1RAs in T2DM patients initiating exenatide once weekly (QW), exenatide twice daily (BID), or once-daily liraglutide (initiated therapy = index therapy). Patients were included if they had T2DM, were GLP-1RA-naïve, initiated a GLP-1RA from 02/01/2012–01/31/2013 (date of initiation = index), were ≥18 years at index, and had continuous enrollment for 12 months before (baseline) to 6 months after index (follow-up). Study outcome was index GLP-1RA adherence (proportion of days covered [PDC] during follow-up, dichotomized at ≥80% vs. <80%, and at ≥90% vs. <90%). Multivariable logistic regressions compared adherence between the GLP-1RAs, adjusting for potential confounders. Sensitivity analyses were performed separating liraglutide by dose (1.2 mg/1.8 mg).

Results

Study sample included 4,041 exenatide QW, 4,586 exenatide BID, and 14,211 liraglutide (6,641 1.2 mg, 7,570 1.8 mg) patients. Median unadjusted PDC values were 0.783 for exenatide QW, 0.500 exenatide BID, 0.722 liraglutide, 0.761 liraglutide 1.2 mg, and 0.683 liraglutide 1.8 mg. Compared with patients treated with either exenatide BID or liraglutide, patients treated with exenatide QW had a statistically significantly greater multivariable-adjusted odds of achieving adherence of ≥80% (odds ratio vs. exenatide QW (OR) = 0.41 for exenatide BID; 0.80, liraglutide; 0.87, liraglutide 1.2 mg; 0.75, liraglutide 1.8 mg) and ≥90% (OR = 0.31 for exenatide BID; 0.60 liraglutide; 0.66 liraglutide 1.2 mg; 0.56 liraglutide 1.8 mg) (all P < 0.001).

Conclusion

Patients initiating exenatide QW had significantly higher adjusted odds of adherence compared with patients initiating other GLP-1RAs. Given differences in adherence across the GLP-1RAs, research correlating these factors with clinical and economic outcomes is warranted.

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Acknowledgments

This study was sponsored by AstraZeneca, Fort Washington, PA, and Bristol-Myers Squibb, Plainsboro, NJ. AstraZeneca funded the article processing fees. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Boris Ivanov, employee of Truven Health Analytics, provided statistical programming support for this study.

Conflict of interest

Stephen Johnston is an employee of Truven Health Analytics. Katherine Cappell is an employee of Truven Health Analytics. James Nelson is an employee of Truven Health Analytics. Bong-Chul Chu is an employee of Truven Health Analytics. Truven Health Analytics was paid by the study sponsors to conduct this study. Hiep Nguyen is an employee of AstraZeneca and was an employee of Bristol-Myers Squibb at the time this study was conducted. Iftekhar Kalsekar is an employee of AstraZeneca and was an employee of Bristol-Myers Squibb at the time this study was conducted. Eugene Felber is an employee of Bristol-Myers Squibb.

Compliance with ethics guidelines

This article does not contain any new studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Truven Health Analytics, 7700 Old Georgetown Rd, Suite 650, Bethesda, MD, 20814, USA

    Stephen S. Johnston

  2. AstraZeneca, 601 Office Center Dr, Suite 200, Fort Washington, PA, 19034, USA

    Hiep Nguyen & Iftekhar Kalsekar

  3. Bristol-Myers Squibb, 777 Scudders Mill Rd, Plainsboro, NJ, 08536, USA

    Eugene Felber

  4. Truven Health Analytics, 777 E Eisenhower Pkwy, Ann Arbor, MI, 48108, USA

    Katherine Cappell & James K. Nelson

  5. Truven Health Analytics, 5425 Hollister Avenue, Suite 140, Santa Barbara, CA, 93111, USA

    Bong-Chul Chu

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Correspondence to Stephen S. Johnston.

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Johnston, S.S., Nguyen, H., Felber, E. et al. Retrospective Study of Adherence to Glucagon-like Peptide-1 Receptor Agonist Therapy in Patients with Type 2 Diabetes Mellitus in the United States. Adv Ther 31, 1119–1133 (2014). https://doi.org/10.1007/s12325-014-0166-0

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