Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment. (3rd June 2018)

• Record Type: Journal Article
• Authors: Mody, Reema; Grabner, Michael; Yu, Maria; Turner, Ralph; Kwan, Anita Y. M.; York, Whitney; Fernández Landó, Laura
• Is Part Of: Current medical research and opinion. Volume 34:Number 6(2018)
• Page Start: 995
• Page End: 1003
• Publication Date: 2018-06-03
• Subjects: Dulaglutide -- GLP-1 receptor agonists -- effectiveness -- adherence -- HbA1c; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2017.1421146
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objectives: To assess glycemic effectiveness, adherence and persistence within 6 months of treatment initiation with dulaglutide, a once weekly GLP-1 receptor agonist, in a US real-world setting. Methods: This retrospective claims analysis included adults (≥18 years) with T2DM from the HealthCore Integrated Research Database, who had HbA1c laboratory results around initiation and within 6 months after initiation. Glycemic control was assessed by change in HbA1c from pre-initiation to post-initiation. Patients were considered adherent if their proportion of days covered (PDC) was ≥0.80; persistence was measured as days of continuous therapy from initiation to 6 months after initiation with no gaps >45 days between fills. Results: Of the 308 analyzed patients, the majority ( n = 188; 61%) were adherent to dulaglutide (mean PDC 0.76; SD 0.26), with 115 patients (37%) discontinuing treatment. Mean persistence was 152 days/5 months. Mean HbA1c decreased from 8.49% (SD 1.70, median 8.20%) at baseline to 7.59% (SD 1.51, median 7.30%) at follow-up, corresponding to a mean HbA1c change of −0.90% (95% confidence interval [CI] −1.08 to −0.73; p < .01; median −0.70%). Patients who were adherent to or persistent with dulaglutide experienced larger reductions (−1.14% and −1.12% respectively), as did those without prior GLP-1 RA use (−1.03%). The proportion of patients with HbA1c <7% increased from 18% to 40%. Conclusions: Dulaglutide was associated with a significant decrease in HbA1c levels 6 months after treatment initiation. Patients who adhered to or persisted with dulaglutide therapy, or were naïve to GLP-1 RA use, experienced greater decreases in HbA1c levels.