Comparative Glycemic Effectiveness of Dulaglutide vs. Liraglutide and Exenatide QW in a U.S. Real-World Setting
Authors: MODY REEMA , HUANG QING , YU MARIA , PATEL HIREN , ZHAO RUIZHI , GRABNER MICHAEL , LANDO LAURA FERNANDEZ 
Published: June 2018

The objective of this retrospective observational study was to compare 6-month and 1-year real-world glycemic effectiveness among patients initiating GLP-1 receptor agonists (GLP-1RA), dulaglutide (DULA) vs. liraglutide (LIRA) or DULA vs. exenatide QW (EQW), using U.S. claims data from the HealthCore Integrated Research Database (HIRD®) between November 2014 and May 2016 (index date=earliest GLP-1RA fill date).
Patients ≥18 years old, with T2DM, no claim for any GLP-1RA in the 6 months pre-index period (baseline), continuous enrollment 6 months pre- and 1-year post-index, ≥1 HbA1c result pre-index and 1-year post-index were included. DULA users were propensity-matched 1:1 to LIRA (585 pairs) or EQW (422 pairs) users. Matched cohorts were balanced in baseline patient characteristics including mean HbA1c. The mean age of all cohorts was 53 years and approximately 50% were males. Among the DULA vs. LIRA matched cohorts, 59% and 41% initiated on DULA 0.75mg and 1.5mg QW, respectively, and 44% and 56% initiated on LIRA 0.6/1.2mg and 1.8 mg QD, respectively. The key effectiveness results are included in the table.
At both 6-month and 1-year post-index, patients initiating DULA experienced a greater reduction in HbA1c compared to LIRA or EQW initiators (p &lt;0.05). In all cohorts, patients adherent to their GLP-1RA treatment had greater reductions in HbA1c than non-adherent patients (p &lt;0.05).Table: Real-world glycemic effectiveness outcomes among GLP-1RA initiatorsMatched DULA vs. LIRA cohortsMatched DULA vs. EQW1 cohortsDULALIRADULAEQW6-month post-index outcomes2, n420433307296HbA1c Outcomes, mean(SD)Pre-index HbA1c result38.71 (1.76)8.67 (1.73)8.76 (1.76)8.64 (1.81)Change in HbA1c from baseline-1.10 (1.67)-0.86 (1.58)*-1.15 (1.69)-0.92 (1.68)*Change in HbA1c among adherent patients4-1.29 (1.57)‡-1.04 (1.49)‡-1.34 (1.64)‡-1.24 (1.57)‡Change in HbA1c among non-adherent patients4-0.75 (1.79)-0.70 (1.64)-0.76 (1.73)-0.73 (1.72)12-month post-index outcomes5, n585585422422HbA1c Outcomes, mean(SD)Pre-index HbA1c result38.78 (1.82)8.73 (1.81)8.83 (1.85)8.89 (1.95)Change in HbA1c from baseline-0.98 (1.70)-0.77 (1.72)*-1.00 (1.76)-0.77 (1.79)*Change in HbA1c among adherent patients6-1.25 (1.58)‡-1.(1.70)‡-1.32 (1.68)‡-1.11 (1.35)‡Change in HbA1c among non-adherent patients6-0.68 (1.79)-0.57 (1.70)-0.60 (1.77)-0.63 (1.93)* Significant difference in mean HbA1c change between the matched cohorts with p value &lt;0.05‡ Significant difference in mean HbA1c change between adherent and non-adherent patients within each cohort with p value &lt;0.051 The study included only exenatide QW pen users2 Assessed among subgroup of patients with 6-month post-index HbA1c results (between index date + 93 days and index date + 228 days)3 Pre-index HbA1c results were obtained between index date - 183 days and index date + 14 days4 Adherent patients were defined as those with proportion of days covered (PDC) ≥80% at 6-month post-index5 Assessed among patients with 1-year post-index HbA1c results (between index date + 275 days and index date + 410 days)6 Adherent patients were defined as those with proportion of days covered (PDC) ≥80% at 1-year post-index

Disclosure
R. Mody: Employee; Self; Eli Lilly and Company. Q. Huang: Other Relationship; Self; Eli Lilly and Company. M. Yu: Employee; Self; Eli Lilly and Company. H. Patel: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. R. Zhao: Other Relationship; Self; Eli Lilly and Company. M. Grabner: Employee; Self; HealthCore, Inc. L. Fernandez Lando: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.