Real-world use of tirzepatide among individuals without evidence of type 2 diabetes: Results from the Veradigm® database

Abstract

Aims: To understand real-world tirzepatide use among individuals without type 2 diabetes (T2D) diagnoses in a US electronic health record (EHR) database.

Materials and methods: This retrospective, descriptive, cohort study used Veradigm's® Network EHR database linked with administrative claims. Adults (≥18 years) included had ≥1 tirzepatide prescription (index period: 13 May 2022-31 August 2023); continuous medical and pharmacy enrolment for ≥12 months pre-index; and no T2D diagnosis or baseline T2D medications except metformin (overall cohort). 'Anti-obesity medication (AOM)-eligible cohort' included individuals with body mass index (BMI) ≥30 or ≥27 kg/m² and ≥1 obesity-related complication (ORC) and ≥6 months of continuous post-index enrollment.

Results: The overall cohort included 10,193 individuals (mean age: 45.0 years; female: 77.1%). Among 6623 individuals with BMI data, 5931 were AOM-eligible. Of these, 3470 had 6-month follow-up data (AOM-eligible cohort; ≥1 ORC: 76.5%; ≥2 ORCs: 51.8%). Treatment patterns at 6 months were assessed among 755 individuals with complete claims data in the AOM-eligible cohort. Most individuals (95.6%) were initiated on a tirzepatide dose of ≤5 mg. At the fifth prescription refill (n = 448), 91.1% were receiving tirzepatide doses of ≤10 mg. At 6 months, tirzepatide adherence was 55.5% and persistence was 54.2%. Among discontinued individuals (n = 346), 10.1% switched to an alternate AOM.

Conclusions: Majority of individuals in the AOM-eligible cohort had ≥1 ORC, and half had ≥2 ORCs, indicating that in this study cohort tirzepatide was being used in people with multimorbidity. Tirzepatide dose escalation in this real-world cohort was slower than in clinical trials, which may have implications for its real-world effectiveness.

Keywords: obesity; tirzepatide; treatment patterns.

FIGURE 1

Tirzepatide dose distribution in anti‐obesity medication (AOM)‐eligible individuals (6‐month follow‐up period). AOM‐eligible cohort: Individuals (≥18 years) without T2D diagnosis and no use of antihyperglycaemic medications (except metformin) who met the AOM‐eligibility criteria and had a 6‐month post‐index follow‐up. This analysis was conducted in the subset of individuals who initiated tirzepatide between 1 May 2022 and 31 December 2022, to ensure that the pharmacy claims data were relatively complete for the AOM‐eligible cohort through the end of the 6‐month follow‐up period.