Zimner Rapuch Sarah, Divino Victoria, Norrbacka Kirsi, Boye Kristina, Lebrec Jeremie, Rosilio Myriam, DeKoven Mitch, Guerci Bruno
Lilly France, 24, Boulevard Vital Bouhot, 92521, Neuilly-sur-Seine, France.
IQVIA, Falls Church, VA, USA.
Diabetes Ther. 2021 May;12(5):1553-1567. doi: 10.1007/s13300-021-01055-5. Epub 2021 Apr 17.
In type 2 diabetes (T2D), persistence with injectable glucose-lowering therapy is associated with better outcomes. This study used real-world pharmacy data to report on persistence with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with T2D in France.
This retrospective cohort analysis presents longitudinal data from approximately 7500 French retail pharmacies that filled GLP-1-RA prescriptions for GLP-1 RA-naïve patients with T2D ('index therapy': dulaglutide; once-weekly exenatide [exenatide QW]; twice-daily exenatide [exenatide BID]; liraglutide) between January 2015 and December 2016 (follow-up ≥ 12 months). The main outcome was treatment persistence (absence of discontinuation [gap following index therapy prescription ≥ 2-fold the expected duration of that prescription] or switch [new non-index glucose-lowering prescription issued ≤ 30 days before/after index therapy discontinuation]). Persistence was calculated as the median duration through Kaplan-Meier survival analysis over the variable follow-up period and as the proportion of patients persistent at 12 months. In addition to persistence outcomes (discontinuation/switch), three other treatment modifications were assessed: augmentation/intensification with a new non-index glucose-lowering therapy; off-label dose increase (daily dose > 20 μg for exenatide BID; two consecutive prescriptions with daily dose > 1.8 mg for liraglutide); and off-label dose decrease (two consecutive prescriptions with average daily dose lower than the index dose). Off-label dose changes were not assessed for dulaglutide or exenatide QW (as single-dose, prefilled pens).
Median persistence was longest for dulaglutide (373 days) versus liraglutide (205 days), exenatide QW (184 days) and exenatide BID (93 days). Twelve months after treatment initiation, the percentage of persistent patients ranged from 51% (dulaglutide) to 21% (exenatide BID). Overall, treatment modification occurred less commonly for dulaglutide than for the other index GLP-1 RAs.
This analysis revealed marked differences in persistence among GLP-1 RAs, which was highest for dulaglutide and lowest for exenatide BID. The prospective TROPHIES study will provide additional information about persistence with dulaglutide and liraglutide, including reasons for treatment modifications.
在2型糖尿病（T2D）中，坚持使用注射用降糖疗法与更好的治疗效果相关。本研究利用真实世界药房数据报告了法国T2D患者使用胰高血糖素样肽-1受体激动剂（GLP-1 RAs）的持续用药情况。
这项回顾性队列分析呈现了2015年1月至2016年12月期间约7500家法国零售药房为初治T2D患者开具GLP-1 RA处方（“索引治疗”：度拉糖肽；每周一次艾塞那肽[艾塞那肽QW]；每日两次艾塞那肽[艾塞那肽BID]；利拉鲁肽）的纵向数据（随访≥12个月）。主要结局是治疗持续性（无停药[索引治疗处方后间隔≥该处方预期时长的2倍]或换药[在索引治疗停药前/后≤30天开具新的非索引降糖处方]）。持续性通过Kaplan-Meier生存分析计算变量随访期内的中位持续时间以及12个月时持续用药患者的比例。除了持续性结局（停药/换药），还评估了其他三种治疗调整：增加/强化新的非索引降糖治疗；超说明书剂量增加（艾塞那肽BID每日剂量>20μg；利拉鲁肽连续两次处方每日剂量>1.8mg）；以及超说明书剂量减少（连续两次处方平均每日剂量低于索引剂量）。度拉糖肽或艾塞那肽QW（单剂量预填充笔）未评估超说明书剂量变化。
度拉糖肽（373天）的中位持续性最长，而利拉鲁肽（205天）、艾塞那肽QW（184天）和艾塞那肽BID（93天）较短。治疗开始12个月后，持续用药患者的百分比范围为51%（度拉糖肽）至21%（艾塞那肽BID）。总体而言，度拉糖肽的治疗调整比其他索引GLP-1 RAs更少见。
该分析揭示了GLP-1 RAs在持续性方面存在显著差异，度拉糖肽的持续性最高，艾塞那肽BID最低。前瞻性TROPHIES研究将提供有关度拉糖肽和利拉鲁肽持续性的更多信息，包括治疗调整的原因。
