Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Front Endocrinol (Lausanne). 2022 Jul 15;13:892702. doi: 10.3389/fendo.2022.892702. eCollection 2022.
This study aims to evaluate the effectiveness and tolerability of once-weekly glucagon-like peptide receptor agonists (OW GLP-1RAs) and to assess the clinical benefits of switching from one GLP-1RA to another (switchers) in a routine clinical setting.
This is a retrospective, real-world cohort study, based on electronic medical records utilized in one Italian diabetes clinic. Estimated mean changes in HbA1c and body weight after 6 and 12 months from the first prescription of a long-acting GLP1-RA were evaluated using longitudinal linear mixed models for repeated measures. The effectiveness of the three long-acting GLP1-RAs was compared separately in the GLP1-RA naive and switchers cohorts, after propensity score adjustment.
Initiating a long-acting GLP1-RA was associated with statistically significant improvements in HbA1c (-1%) and body weight (-2.6 kg) after 6 months, and benefits were maintained after 12 months. In GLP1-RA naive cohort, semaglutide showed the largest effect on HbA1c (-1.55%; 95%CI, -1.77;-1.34) and body weight (-3.76 kg; 95%CI, -5.05;-2.47) at 6 months, maintained at 12 months (-1.55%; 95%CI, -1.82;-1.28 and -6.29 kg; 95%CI, -7.94;-4.63). In the switchers' cohort, statistically significant reductions at 6 months in HbA1c and body weight were documented with semaglutide and dulaglutide only, with semaglutide associated with the most marked reduction (-0.84%; 95%CI, -1.03;-0.65 and -3.43 kg; 95%, -4.67;-2.19). Dropout rates were 9.2%, 28.5%, and 41.7% in semaglutide, dulaglutide, and exenatide groups, respectively.
The effectiveness and tolerability of the OW GLP-1RAs in the real world were documented. Semaglutide was associated with the highest response without impact on safety. Clinical improvements were obtained even in switchers, especially in those switching to semaglutide.
本研究旨在评估每周一次胰高血糖素样肽受体激动剂（OW GLP-1RAs）的有效性和耐受性，并评估在常规临床环境中从一种 GLP-1RA 转换为另一种 GLP-1RA（转换者）的临床获益。
这是一项基于意大利一家糖尿病诊所电子病历的回顾性真实世界队列研究。使用纵向线性混合模型对重复测量，评估长效 GLP1-RA 首次处方后 6 个月和 12 个月时 HbA1c 和体重的估计平均变化。在倾向评分调整后，分别比较了三种长效 GLP1-RAs 在 GLP1-RA 初治和转换者队列中的有效性。
起始长效 GLP1-RA 治疗 6 个月后 HbA1c（-1%）和体重（-2.6kg）有统计学意义的改善，12 个月后仍有获益。在 GLP1-RA 初治队列中，司美格鲁肽在 6 个月时对 HbA1c（-1.55%；95%CI，-1.77%；-1.34%）和体重（-3.76kg；95%CI，-5.05%；-2.47%）的作用最大，12 个月时仍保持（-1.55%；95%CI，-1.82%；-1.28%和-6.29kg；95%CI，-7.94%；-4.63%）。在转换者队列中，仅司美格鲁肽和度拉糖肽在 6 个月时记录到 HbA1c 和体重的统计学显著降低，司美格鲁肽与最显著的降低相关（-0.84%；95%CI，-1.03%；-0.65%和-3.43kg；95%CI，-4.67%；-2.19%）。司美格鲁肽、度拉糖肽和艾塞那肽组的脱落率分别为 9.2%、28.5%和 41.7%。
在真实世界中，OW GLP-1RAs 的有效性和耐受性得到了证实。司美格鲁肽与安全性无影响下的最高反应相关。即使在转换者中也获得了临床改善，特别是在转换为司美格鲁肽的患者中。
