Real-world patterns in GLP-1 RA switching from 2018-2023 in the US

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Authors: Brianna M. Goodwin Cartwright, MS Truveta, Inc, Bellevue, WA, Patricia J. Rodriguez, PhD MPH Truveta, Inc, Bellevue, WA, Samuel Gratzl, PhD Truveta, Inc, Bellevue, WA, Charlotte Baker, DrPH MPH CPH Truveta, Inc, Bellevue, WA, Duy Do, PhD Truveta, Inc, Bellevue, WA, Nicholas Stucky, MD PhD Truveta, Inc, Bellevue, WA
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.

Truveta Research uses EHR data to explore medication switching trends from Humira to approved biosimilars following the CVS formulary changes
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%).