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. 2022 Jan;10(1):e002517.
doi: 10.1136/bmjdrc-2021-002517.

Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK

Tracey Weiss  1 , Lingfeng Yang  2 , Richard D Carr  2   3 , Sampriti Pal  4 , Baanie Sawhney  4 , Robert Boggs  2 , Swapnil Rajpathak  2 , Kristy Iglay  2
Affiliations

Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK

Tracey Weiss et al. BMJ Open Diabetes Res Care. 2022 Jan.

Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a type 2 diabetes mellitus (T2DM) treatment with demonstrated weight loss benefits in clinical trials. However, the extent to which real-world patients with T2DM achieve clinically meaningful weight loss (≥5%) has not been well characterized. Analysis of real-world data suggests adherence to injectable GLP-1 RAs is suboptimal and discontinuation following the first year of therapy is poorly characterized.

Research design and methods: A retrospective cohort study among patients with T2DM initiating injectable GLP-1 RA therapy was conducted using the Clinical Practice Research Datalink that includes primary care medical records for 13 million patients in the UK. This study assessed weight change, adherence (proportion of days covered (PDC) ≥80%), and discontinuation (≥90-day gap between prescriptions) at 12 and 24 months during the study period spanning January 2009-December 2017.

Results: Among 589 patients initiating a GLP-1 RA, 56.4% were female and the median age was 54 years (IQR (46, 61)). The median body mass index was 41.2 kg/m2 (IQR (35.8, 46.4)). Among patients with weight measures available (n=341 at 12 months; n=232 at 24 months), 33.4% and 43.5% achieved weight loss ≥5% of baseline weight at 12 and 24 months, respectively. At 12 and 24 months, 64.5% and 59.2% were adherent, and 45.2% and 64.7% discontinued, respectively.

Conclusions: A minority of patients initiating GLP-1 RAs achieved ≥5% weight loss, suggesting the real-world benefit of these agents on weight loss may be lower than that observed in clinical trials. Patients on GLP-1 RAs may benefit from additional support to improve long-term adherence.

Keywords: adherence; diabetes mellitus; type 2; weight change.

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Conflict of interest statement

Competing interests: TW, LY, RB, SR, and KI are/were employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey, USA at the time of study conduct. RDC was an employee of MSD UK, London, UK at the time of study conduct and holds an honorary position at University College, London, UK. BS and SP were external contractors of Complete HEOR Solutions whose analysis services were paid for by Merck & Co., Inc.

Figures

Figure 1
Figure 1
Per cent of patients who were adherent to (n=530)† and discontinued (n=589) GLP-1 RA therapy at 12 and 24 months. †Adherence assessed among patients with two or more GLP-1 RA prescriptions. BMI, body mass index; GLP-1 RA, glucagon-like peptide-1 receptor agonist.
Figure 2
Figure 2
Time to discontinuation of GLP-1 RAs, Kaplan-Meier plot, n=589. Patients discontinued a median of 426 days (95% CI 384 to 474) after initiating GLP-1 RA therapy.GLP-1 RA, glucagon-like peptide-1 receptor agonist.
See this image and copyright information in PMC

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