Glycemic Control and Weight Outcomes for Exenatide Once Weekly Versus Liraglutide in Patients with Type 2 Diabetes: A 1-Year Retrospective Cohort Analysis

• Published in: Clinical therapeutics 2016-12, Vol.38 (12), p.2642-2651
• Main Authors: McAdam-Marx, Carrie, PhD, RPh, Nguyen, Hiep, MPH, MS, Schauerhamer, Marisa B., PharmD, Singhal, Mukul, PhD, BPh, Unni, Sudhir, MBA, PhD, Ye, Xiangyang, MS, Cobden, David, PhD, MPH, MS
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory care; Blood Glucose - analysis; Body mass index; Body Weight - drug effects; Comorbidity; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - physiopathology; Endocrinology; Exenatide; Female; Glucagon-Like Peptide-1 Receptor - agonists; Glycated Hemoglobin A - analysis; glycemic control; Humans; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Internal Medicine; liraglutide; Liraglutide - therapeutic use; Male; Medical Education; Medical records; Middle Aged; observational study; Patients; Peptides - therapeutic use; Retrospective Studies; Variables; Venoms - therapeutic use; weight
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.11.003

Abstract Purpose Data comparing real-world effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) exenatide once weekly (QW) and liraglutide in the treatment of type 2 diabetes (T2D) are limited. Furthermore, there is limited information on exenatide QW or liraglutide response by glycemic control and insulin use status. This study identifies 1-year glycosylated hemoglobin (HbA1c ) and weight outcomes with exenatide QW and liraglutide in the real-world setting overall and in insulin-naive patients with uncontrolled T2D. Methods This retrospective cohort study using national electronic medical record data compared 1-year HbA1c and weight outcomes in patients with T2D prescribed exenatide QW or liraglutide. Included patients were adults (≥18 years old) with T2D who were GLP-1RA naive when newly prescribed exenatide QW or liraglutide between January 1, 2012, and March 31, 2013 (index date). Outcomes were reported descriptively overall and in subsets of insulin-naive patients with baseline HbA1c ≥7.0% or ≥9.0%. Multivariable linear regression analyses were performed to estimate adjusted change in HbA1c and weight. Findings The study included 808 exenatide QW and 4333 liraglutide patients. Mean (SD) age was 57 (11) years in both groups. Mean baseline HbA1c was 8.3% (1.5%) in exenatide QW patients and 8.4% (1.6%) in liraglutide patients ( P = 0.66); 16 (2%) of the exenatide QW and 1099 (25.4%) of the liraglutide patients were newly prescribed insulin on the index date ( P < 0.001). Adjusted mean HbA1c change at 1 year was −0.37% (95% CI, −0.53% to −0.21%) for exenatide QW and −0.37% (95% CI, −0.55% to −0.18%) for liraglutide. Adjusted HbA1c reduction was more pronounced in insulin-naive patients with baseline HbA1c ≥7.0% (−0.71% and −0.80% for the exenatide QW and liraglutide patients, respectively, P > 0.05) and ≥9.0% (−1.73% and −1.57% for exenatide QW and liraglutide patients, respectively, P > 0.05). Mean (adjusted) weight loss was −2.22 kg (95% CI, −3.06 to −1.37 kg) with exenatide QW and −2.21 kg (95% CI, −3.18 to −1.23 kg) with liraglutide. Implications Exenatide QW and liraglutide lead to similar HbA1c and weight reductions at 1 year in the real-world setting. Greater HbA1c reductions occurred in insulin-naive patients with baseline HbA1c ≥7.0%. Both agents are appropriate options for patients needing antidiabetes therapy to lower HbA1c while promoting weight loss.