Trends in Clinical Characteristics and Prescribing Preferences for SGLT2 Inhibitors and GLP-1 Receptor Agonists, 2013–2018

Feb 12, 2020Diabetes care

Changes in Patient Features and Prescription Choices for Two Diabetes Drug Types from 2013 to 2018

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Abstract

Over 5 years, empagliflozin initiation increased by 57.1%, while canagliflozin initiation declined by 75.1%.

Empagliflozin was the only SGLT2 inhibitor with an increase in the proportion of patients with cardiovascular disease or heart failure.
Liraglutide initiation as a proportion of GLP-1 receptor agonists decreased by 32.1%, whereas dulaglutide initiation increased by 34.1%.
The proportion of patients with cardiovascular disease or heart failure increased by 5.1% among liraglutide initiators.
Most prescribers of these medications were internists or endocrinologists, while cardiologist prescribing remained low.

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OBJECTIVE: There is a paucity of data evaluating recent changes in clinical and prescriber characteristics of patients initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA).

RESEARCH DESIGN AND METHODS: U.S.-based administrative claims data (July 2013 to June 2018) were used to identify initiators of SGLT2i and GLP-1RA.

RESULTS: Over 5 years, empagliflozin initiation (as a proportion of SGLT2i) increased by 57.1% (< 0.001 for trend), while canagliflozin initiation declined by 75.1% (< 0.001). Empagliflozin was the only agent within SGLT2i with an increase in the proportion of patients with myocardial infarction, stroke, or heart failure (collectively called CVD-HF) (< 0.001). Liraglutide initiation (as a proportion of total GLP-1RA) declined by 32.1% (< 0.001), and dulaglutide initiation increased by 34.1% (< 0.001); the proportion of patients with CVD-HF increased the most in liraglutide initiators (5.1% increase;< 0.001). Most prescribers were internists or endocrinologists; cardiologist prescribing remained low (<1%). P P P P P P

CONCLUSIONS: For SGLT2i, shifts in preference for empagliflozin followed changes in drug labels and guidelines, while for GLP-1RA, other factors such as price or ease of administration may have led to a preference for dulaglutide over liraglutide.

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Trends in Clinical Characteristics and Prescribing Preferences for SGLT2 Inhibitors and GLP-1 Receptor Agonists, 2013–2018

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