Divino Victoria, DeKoven Mitch, Hallinan Shawn, Varol Nebibe, Wirta Sara Bruce, Lee Won Chan, Reaney Matthew
Health Economics and Outcomes Research Real-World Evidence Solutions, IMS Health, Fairfax, VA, USA,
Diabetes Ther. 2014 Dec;5(2):499-520. doi: 10.1007/s13300-014-0087-6. Epub 2014 Nov 4.
The objective of this study was to evaluate real-world treatment patterns of type 2 diabetes (T2D) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Germany (GE), the United Kingdom (UK), France (FR), the Netherlands (NE), Belgium (BE), and Sweden (SE).
Adult T2D patients initiating exenatide twice daily (exBID), liraglutide once daily (LIRA) or exenatide once weekly (exQW) were identified using the IMS LifeLink™ (IMS Health, Danbury, CT, USA): Electronic Medical Records (EMR; GE/UK/FR) and IMS LifeLink™: longitudinal prescriptions (LRx; NE/BE/GE/UK) databases, and national health register data (SE), between 2010 and 2012. Therapy initiation date was termed 'index date'. Eligible patients had ≥180-day pre- and variable follow-up (minimum ≥360-day post-index exBID and LIRA, ≥180-day post-index exQW). Treatment modification and persistence were evaluated over 180 days. Kaplan-Meier (KM) survival curves and Cox proportional hazards models (PHMs; EMR databases only) evaluated stopping of the index therapy (measured as first of discontinuation or switch).
30,206 exBID, 5,401 exQW, and 52,155 LIRA patients were included in the analysis (46.0-66.9% male; mean age range 55.4-59.3 years). Mean follow-up was 20.3-27.4 months for exBID and LIRA, and 7.6-13.9 months for exQW. Across the databases, the proportion experiencing a treatment modification at 180 days was highest among exBID (37.6-81.7%) compared to LIRA (36.8-56.6%) and exQW (32.3-47.7%). The proportion persistent at 180 days was lowest among exBID patients (46.8-73.5%) compared to LIRA (50.6-80.1%) or exQW (57.5-74.6%). In the KM analyses, LIRA patients had a lower proportion stopping therapy at all time points compared to exBID patients, across the databases. In the Cox PHMs, LIRA was associated with a significantly lower risk of stopping compared to exBID; in GE, exQW was associated with a lower risk compared to exBID and LIRA.
Treatment patterns varied among GLP-1 RA patients, with persistence highest among either LIRA or exQW across countries, and lowest among exBID. Longer-term data would be useful, particularly given limited exQW follow-up due to more recent launch.
本研究的目的是评估在德国（GE）、英国（UK）、法国（FR）、荷兰（NE）、比利时（BE）和瑞典（SE）开始使用胰高血糖素样肽-1受体激动剂（GLP-1 RAs）的2型糖尿病（T2D）患者的真实世界治疗模式。
使用IMS LifeLink™（美国康涅狄格州丹伯里市的IMS Health公司）的电子病历（EMR；GE/UK/FR）和IMS LifeLink™：纵向处方（LRx；NE/BE/GE/UK）数据库以及国家健康登记数据（SE），识别出2010年至2012年间开始每日两次注射艾塞那肽（exBID）、每日一次注射利拉鲁肽（LIRA）或每周一次注射艾塞那肽（exQW）的成年T2D患者。治疗开始日期被称为“索引日期”。符合条件的患者有≥180天的基线期和可变随访期（exBID和LIRA索引日期后至少≥360天，exQW索引日期后至少≥180天）。在180天内评估治疗调整和持续性。使用Kaplan-Meier（KM）生存曲线和Cox比例风险模型（PHMs；仅用于EMR数据库）评估索引治疗的停药情况（以停药或换药中的首次发生为准）。
分析纳入了30206例exBID患者、5401例exQW患者和52155例LIRA患者（男性占46.0 - 66.9%；平均年龄范围为55.4 - 59.3岁）。exBID和LIRA的平均随访时间为20.3 - 27.4个月，exQW为7.6 - 13.9个月。在各个数据库中，180天时经历治疗调整的比例在exBID患者中最高（37.6 - 81.7%），高于LIRA患者（36.8 - 56.6%）和exQW患者（32.3 - 47.7%）。180天时仍持续治疗的比例在exBID患者中最低（46.8 - 73.5%），低于LIRA患者（50.6 - 80.1%）或exQW患者（57.5 - 74.6%）。在KM分析中，在各个数据库中，与exBID患者相比，LIRA患者在所有时间点停药的比例都较低。在Cox PHMs中，与exBID相比，LIRA停药风险显著更低；在德国，与exBID和LIRA相比，exQW停药风险更低。
GLP-1 RA患者的治疗模式各不相同，各国中LIRA或exQW的持续性最高，exBID最低。鉴于exQW由于上市较晚随访时间有限，长期数据将很有用。
