Treatment persistence in patients with type 2 diabetes treated with glucagon‐like peptide‐1 receptor agonists in clinical practice in Sweden

Abstract

Aim ‐ To compare treatment persistence in patients with type 2 diabetes mellitus initiating the glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) dulaglutide, exenatide once‐weekly (QW), liraglutide, or lixisenatide in routine clinical practice in Sweden and assess clinical outcomes. Materials and Methods We performed a retrospective study using data from several nationwide Swedish health registries, including the National Diabetes Register and other mandatory and population‐based registries. Individual level data were collected from 17,361 patients who initiated GLP‐1 RA treatment between the 23 May 2015 and the 15 Oct 2017, up to 2.5 years post‐index (treatment start date). Treatment persistence and modification, predictors of discontinuation, glycated hemoglobin A1c (HbA1c), and body weight were recorded. Non‐persistence was defined as a treatment gap of >45 days. Treatment modification included switching and augmentation. Confounding was addressed through the use of propensity scores. Results Treatment persistence was higher and treatment modifications were lower in patients initiating dulaglutide, compared with those on exenatide QW, liraglutide, and lixisenatide. Patients who remained on the same treatment for 1‐year post‐index experienced greater HbA1c reductions and a steadier decrease in body weight, compared with those who switched treatment. Conclusions Our study suggests that in clinical practice in Sweden, there is a greater persistence of treatment among patients initiating dulaglutide, compared with those on exenatide QW, liraglutide, and lixisenatide. Persistence with the index GLP‐1 RA was closely correlated with positive clinical outcomes and should thus be considered a critical factor of patient‐centric treatment in Sweden.