Real-world patterns in GLP-1 RA switching from 2018-2023 in the US
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Date: August, 2024
Abstract
Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have surged in popularity, however increasing demand and global shortages may prevent patients from accessing their prescribed medications.
Objective
To describe demographic and temporal patterns in GLP-1 RA switching.
Methods
Using a subset of EHR data from Truveta, we identified patients with a GLP-1 RA dispense between 2018 and October 2023. EHR data from Truveta included BMI values, conditions, encounters, and medication dispensing for a collective of US healthcare systems. Patients were required to have at least two months of GLP-RA prescription fills. Brand names were used to infer labelled use (anti-obesity medication [AOM] or anti-diabetic medication [ADM]) and route of administration (injectable or oral). Switching was defined as being dispensed a different drug than the previous month. We describe the drugs and months with the highest rates of switching. Results are presented overall and for populations with overweight/obesity (BMI>=27) and type 2 diabetes (T2D).
For dispense data with a supply greater than 30 days, patients were assumed to have supply on hand for subsequent months (i.e., for supply of 60- or 90-days patients were assumed to have supply for 2 or 3 months, respectively). Switching was defined as when a patient filled a different GLP-1 RA drug during two sequential months. We describe the drugs and months with the highest rates of switching.
Results are presented overall for all GLP-1 users and stratified by populations with overweight/obesity (BMI >= 27) or T2D. We identified patients as having a previous T2D diagnosis or having overweight/obesity (BMI >=BMI) using either diagnosis codes or BMI measurements.
Results
Of 1,051,391 eligible patients, 10.9% experienced at least one drug switch. While the overall population is primarily between 45-64 years of age (overall: 51.9%; switched: 57.4%), female (62.1%; 64.3%), white (69.6%; 72.0%), and not Hispanic or Latino (79.1%; 81.2%), the population who switched had higher percentages in each of these groups. Compared to the overall population, slightly higher rates of switching occurred for people with overweight/obesity (overall: 59.8% had overweight/obesity; switched: 60.4% had overweight/obesity), T2D (overall: 41.9%; switched: 44.2%) and those who initiated treatment on or before 2021 (overall: 41.2%; switched: 57.1% ). The population who switched had higher initiation rates on liraglutide labeled for T2D (overall: 11.8%; switched: 20.7%) and lower initiation rates on semaglutide labeled for T2D (overall: 35.5%; switched: 25.1%).
Switching rates were highest in January 2023 (3.0%, 3.0%, and 3.1% of the overall, T2D and overweight/obesity populations, respectively). The majority of the overall population switched from dulaglutide labeled for T2D (26.1%) or semaglutide labeled for T2D (21.0%). The population primarily switched to semaglutide labeled for T2D (24.5%) or tirzepatide labeled for T2D (14.9%). Similar trends were seen for both sub-populations.
The overweight/obesity population also experienced high rates of switching in June 2023 (2.6%). Patients primarily switched from dulaglutide labeled for T2D (17.5%). Patients primarily switched to semaglutide labeled for T2D (28.0%).