Utilization Patterns of Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus in Italy: A Retrospective Cohort Study
Open accessAbstract
INTRODUCTION: Real-world evidence on glucagon-like peptide-1 receptor agonist (GLP-1 RAs) usage is emerging in different European countries but is lacking in Italy. This retrospective cohort study aimed to describe the real-world drug utilization patterns in patients initiating GLP-1 RAs for treating T2DM in Italy. METHODS: Adults aged ≥ 20 years and with ≥ 1 oral antidiabetic drug (alone or in combination with insulin) other than GLP-1 RAs in the 6 months prior to initiating exenatide twice daily (exBID), exenatide once weekly (exQW), dulaglutide once weekly (DULA), liraglutide once daily (LIRA) or lixisenatide once daily (LIXI) between March and July 2016 were retrospectively identified in the Italian IMS LifeLink™ longitudinal prescriptions database (retail pharmacy data). Patients with ≥ 6-month follow-up (defined as evidence of any prescription activity) were included. Proportions of patients who remained persistent (continued treatment until discontinuation/switch) in the first 6 months and of those who discontinued or switched to a different GLP-1 RA over the entire follow-up were recorded. For each treatment, the average daily/weekly dosage (ADD/AWD) while persistent during the available follow-up was calculated. RESULTS: We identified 7319 patients: 92 exBID, 970 exQW, 3368 DULA, 2573 LIRA and 316 LIXI. Across treatments, 89% patients were ≥ 50 years old, 54% were males, and the median follow-up duration ranged between 8.1 and 8.7 months. At 6 months, 35% exBID, 47% exQW, 62% DULA, 50% LIRA and 40% LIXI patients remained persistent. Over the entire follow-up, median persistence days varied from 73 (exBID) to > 300 days (DULA). The mean ± SD ADD/AWD was exBID: 17.7 ± 2.1 µg/day; exQW: 2.1 ± 0.1 mg/week; DULA: 1.5 ± 0.2 mg/week; LIRA: 1.5 ± 0.2 mg/day; LIXI: 21.0 ± 5.5 µg/day. CONCLUSIONS: This real-world analysis suggests differences exist in persistence between patients treated with various GLP-1 RAs. Among the investigated treatments, patients prescribed exBID recorded the lowest and those prescribed DULA the highest persistence with therapy. FUNDING: Eli Lilly and Co., Indianapolis, IN, USA.
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The results for discontinuation by dosing schedule (weekly vs daily) diverge from other real-world studies.
“The results for discontinuation by dosing schedule (weekly vs daily) diverge from other real-world studies for reasons that are unclear.”
From Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK (2022) · cites this paper as [25]
The Conclusions state that this study’s results are aligned with those from other countries, not that they diverge from other real-world studies. The paper reports lower persistence with twice-daily exenatide than with the weekly or other daily treatments. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredDiscontinuation rates in this study were substantially higher than those reported in clinical trials.
“However, the discontinuation rates in this study were substantially higher than those reported in clinical trials.”
From Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK (2022) · cites this paper as [25]
The Results (Table 2; page unavailable) report discontinuation as the first treatment change for 40.4% of patients overall. The paper does not provide clinical-trial discontinuation rates or establish that its rates were substantially higher, so the comparison is unsupported. (LLM, conf=0.82)
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Trends in glucagon-like peptide-1 receptor agonist utilization and expenditure in Croatia
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- Authors
- Federici, M. O., McQuillan, J., Biricolti, G., Losi, S., Lebrec, J., Richards, C., Miglio, C., & Norrbacka, K.
- Affiliations
- Eli Lilly (Italy) (IT)
- IQVIA (United Kingdom) (GB)
- Corresponding author
- Norrbacka, Kirsi
- Venue
- Diabetes Therapy
- Published
- 2018-03-10
- Volume
- 9
- Issue
- 2
- Pages
- 789-801
- ISSN
- 1869-6953 (ISSN-L)
- 1869-6961
- PMC
- PMC6104260
- OpenAlex
- W2793927060
- Cited by
- 37
- References
- 32
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 11 · 2019: 3 · 2018: 1
- FWCI
- 3.98
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Diabetes Therapy (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- GLP-1 receptor agonists, type 2 diabetes, drug utilization patterns, treatment persistence, exenatide twice daily, exenatide once weekly, dulaglutide, liraglutide, lixisenatide, average daily dose, Italian patients, real-world evidence, oral antidiabetic drugs
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