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. 2023 Sep;79(9):1239-1248.
doi: 10.1007/s00228-023-03539-8. Epub 2023 Jul 14.

Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014-2022)

Jialing Lin  1 , Sallie-Anne Pearson  2 , Jerry R Greenfield  3   4   5 , Kyeong Hye Park  2   6 , Alys Havard  2   7 , David Brieger  8   9 , Richard O Day  4   10 , Michael O Falster #  2 , Juliana de Oliveira Costa #  2
Affiliations

Trends in use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in Australia in the era of increased evidence of their cardiovascular benefits (2014-2022)

Jialing Lin et al. Eur J Clin Pharmacol. 2023 Sep.

Abstract

Purpose: To investigate trends in SGLT2i and GLP-1RA use in Australia in the era of increased evidence of their cardiovascular benefits.

Methods: We used national dispensing claims for a 10% random sample of Australians to estimate the number of prevalent and new users (no dispensing in the prior year) of SGLT2i or GLP-1RA per month from January 2014 to July 2022. We assessed prescriber specialty and prior use of other antidiabetic and cardiovascular medicines as a proxy for evidence of type 2 diabetes (T2D) and cardiovascular conditions, respectively.

Results: We found a large increase in the number of prevalent users (216-fold for SGLT2i; 11-fold for GLP-1RA); in July 2022 approximately 250,000 Australians were dispensed SGLT2i and 120,000 GLP-1RA. Most new users of SGLT2i or GLP-1RA had evidence of both T2D and cardiovascular conditions, although from 2022 onwards, approximately one in five new users of SGLT2i did not have T2D. The proportion of new users initiating SGLT2i by cardiologists increased after 2021, reaching 10.0% of initiations in July 2022. Among new users with evidence of cardiovascular conditions, empagliflozin was the most commonly prescribed SGLT2i, while dulaglutide or semaglutide was the most common GLP-1RA.

Conclusion: SGLT2i and GLP-1RA use is increasing in Australia, particularly in populations with higher cardiovascular risk. The increased use of SGLT2i among people without evidence of T2D suggests that best-evidence medicines are adopted in Australia across specialties, aligning with new evidence and expanding indications.

Keywords: Cardiovascular disease; Glucagon-like peptide-1 receptor agonists; Pharmacoepidemiology; Sodium-glucose co-transporter 2 inhibitors; Trends; Type 2 diabetes.

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Conflict of interest statement

SAP is a member of the Drug Utilisation Sub Committee of the Pharmaceutical Benefits Advisory Committee. The views expressed in this paper do not represent those of the Committee.

Figures

Fig. 1
Fig. 1
Timeline of SGLT2i and GLP-1RA listed in the Australian Pharmaceutical Benefits Scheme by indication. SGLT2i, Sodium-glucose co-transporter 2 inhibitors; GLP-1RA, Glucagon-like peptide-1 receptor agonists
Fig. 2
Fig. 2
Monthly trends in the number of prevalent users, January 2014-July 2022. SGLT2i, Sodium-glucose co-transporter 2 inhibitors; GLP-1RA, Glucagon-like peptide-1 receptor agonists
Fig. 3
Fig. 3
Monthly trends in the number of new users by evidence of clinical conditions. SGLT2i, Sodium-glucose co-transporter 2 inhibitors; GLP-1RA, Glucagon-like peptide-1 receptor agonists; CV, Cardiovascular; T2D, Type 2 diabetes. See Table S1 for the details of each clinical trial
Fig. 4
Fig. 4
Monthly trends in the number of new users by specialty of prescriber. SGLT2i, Sodium-glucose co-transporter 2 inhibitors; GLP-1RA, Glucagon-like peptide-1 receptor agonists; GP, General practitioner. See Table S1 for the details of each clinical trial.
Fig. 5
Fig. 5
Percentage of new users with evidence of cardiovascular conditions initiating specific medicines. SGLT2i, Sodium-glucose co-transporter 2 inhibitors; GLP-1RA, Glucagon-like peptide-1 receptor agonists. See Table S1 for the details of each clinical trial
See this image and copyright information in PMC

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