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A retrospective, case-note survey of type 2 diabetes patients prescribed incretin-based therapies in clinical practice.

Evans M, McEwan P, O'Shea R, George L - Diabetes Ther (2012)

Bottom Line: Weight changes were similar for GLP-1RAs but significantly greater vs.DPP-4is (both P < 0.05).Greater body weight reductions occur with GLP-1RAs compared with DPP-4is.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Llandough, Penlan Road, Llandough, Penarth, South Glamorgan, UK, marc.evans2@ntlworld.com.

ABSTRACT

Introduction: While incretin-based therapies have been compared in clinical trials, data comparing their relative efficacy in clinical practice remain limited, particularly when prescribed according to clinical guidelines. This study assessed the clinical and cost-effectiveness of, and patient preference for, incretin-based therapies initiated according to the National Institute for Health and Clinical Excellence (NICE) recommendations in UK clinical practice.

Methods: In a retrospective chart audit, anonymized data were collected for patients receiving incretin-based therapy according to NICE recommendations in clinical practice in Wales, UK. Parameters assessed included glycated hemoglobin (HbA1c), weight, achievement of NICE treatment continuation criteria, adverse events, treatment discontinuation, and drug cost-effectiveness based on observed treatment effects. Treatment preference for a dipeptidyl peptidase-4 inhibitor (DPP-4i) or glucagon-like peptide-1 receptor agonist (GLP-1RA) was assessed prospectively.

Results: Patients (1,114) were followed-up for a median of 48 weeks (256 received liraglutide, 148 received exenatide twice daily, and 710 received a DPP-4i). Liraglutide reduced HbA1c significantly more versus exenatide or DPP-4i (both P < 0.05). Weight changes were similar for GLP-1RAs but significantly greater vs. DPP-4is (both P < 0.05). NICE treatment continuation criteria were met by 32% and 24% of liraglutide 1.2 mg- and exenatide-treated patients (≥1% HbA1c reduction, ≥3% weight loss), and 61% of DPP-4i-treated patients (≥0.5% HbA1c reduction). Life-years gained per patient were 0.12, 0.08, and 0.07, and costs per quality-adjusted life-year were £16,505, £16,648, and £20,661 for liraglutide, exenatide, and DPP-4is, respectively. More patients (62.5%) preferred the GLP-1RA profile, with these patients having higher baseline body mass index score and HbA1c values, and longer diabetes duration than those preferring the DPP-4i profile.

Conclusion: When prescribed according to NICE recommendations, incretin-based therapies are both clinically and cost-effective options, with liraglutide providing greatest HbA1c reductions. Greater body weight reductions occur with GLP-1RAs compared with DPP-4is. Patients with higher baseline HbA1c and longer diabetes duration prefer a GLP-1RA profile versus a DPP-4i.

No MeSH data available.


Related in: MedlinePlus

Mean (SD) reduction in glycated hemoglobin (HbA1c) from baseline to end of audit. *P < 0.05 versus baseline. DPP-4i dipeptidyl peptidase-4 inhibitor, SD standard deviation
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Fig1: Mean (SD) reduction in glycated hemoglobin (HbA1c) from baseline to end of audit. *P < 0.05 versus baseline. DPP-4i dipeptidyl peptidase-4 inhibitor, SD standard deviation

Mentions: Significant reductions in HbA1c from baseline to audit end were apparent in all three treatment groups (all P < 0.05) (Fig. 1). The change in mean HbA1c was significantly greater for liraglutide (1.2 and 1.8 mg) than exenatide or DPP-4is (both P < 0.05), but not for exenatide versus DPP-4i (Fig. 1). Significant reductions in weight from baseline to audit end were observed for patients receiving a GLP-1RA (Fig. 2), with 3.1 and 2.1 kg greater weight reduction seen for liraglutide- and exenatide-treated subjects, respectively, versus those prescribed a DPP-4i. Mean HbA1c or weight at 12 months was not statistically different to the 3-, 6-, and 9-month measurements for each group (Table 3). Considering only those receiving liraglutide 1.8 mg (n = 27), the mean (standard deviation [SD]) HbA1c and body weight reductions from baseline were 1.28% (±0.35) and 4.1 kg (±7.2), respectively. Twelve liraglutide-treated subjects, 32 exenatide-treated subjects, and 25 DPP-4i-treated subjects either failed to complete 3 months of therapy or had no available follow-up data; tolerability issues were the most commonly recorded reason for therapy discontinuation over this time frame (n = 9 [liraglutide]; n = 27 [exenatide], and n = 9 [DPP-4i]).Fig. 1


A retrospective, case-note survey of type 2 diabetes patients prescribed incretin-based therapies in clinical practice.

Evans M, McEwan P, O'Shea R, George L - Diabetes Ther (2012)

Mean (SD) reduction in glycated hemoglobin (HbA1c) from baseline to end of audit. *P < 0.05 versus baseline. DPP-4i dipeptidyl peptidase-4 inhibitor, SD standard deviation
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3687099&req=5

Fig1: Mean (SD) reduction in glycated hemoglobin (HbA1c) from baseline to end of audit. *P < 0.05 versus baseline. DPP-4i dipeptidyl peptidase-4 inhibitor, SD standard deviation
Mentions: Significant reductions in HbA1c from baseline to audit end were apparent in all three treatment groups (all P < 0.05) (Fig. 1). The change in mean HbA1c was significantly greater for liraglutide (1.2 and 1.8 mg) than exenatide or DPP-4is (both P < 0.05), but not for exenatide versus DPP-4i (Fig. 1). Significant reductions in weight from baseline to audit end were observed for patients receiving a GLP-1RA (Fig. 2), with 3.1 and 2.1 kg greater weight reduction seen for liraglutide- and exenatide-treated subjects, respectively, versus those prescribed a DPP-4i. Mean HbA1c or weight at 12 months was not statistically different to the 3-, 6-, and 9-month measurements for each group (Table 3). Considering only those receiving liraglutide 1.8 mg (n = 27), the mean (standard deviation [SD]) HbA1c and body weight reductions from baseline were 1.28% (±0.35) and 4.1 kg (±7.2), respectively. Twelve liraglutide-treated subjects, 32 exenatide-treated subjects, and 25 DPP-4i-treated subjects either failed to complete 3 months of therapy or had no available follow-up data; tolerability issues were the most commonly recorded reason for therapy discontinuation over this time frame (n = 9 [liraglutide]; n = 27 [exenatide], and n = 9 [DPP-4i]).Fig. 1

Bottom Line: Weight changes were similar for GLP-1RAs but significantly greater vs.DPP-4is (both P < 0.05).Greater body weight reductions occur with GLP-1RAs compared with DPP-4is.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Llandough, Penlan Road, Llandough, Penarth, South Glamorgan, UK, marc.evans2@ntlworld.com.

ABSTRACT

Introduction: While incretin-based therapies have been compared in clinical trials, data comparing their relative efficacy in clinical practice remain limited, particularly when prescribed according to clinical guidelines. This study assessed the clinical and cost-effectiveness of, and patient preference for, incretin-based therapies initiated according to the National Institute for Health and Clinical Excellence (NICE) recommendations in UK clinical practice.

Methods: In a retrospective chart audit, anonymized data were collected for patients receiving incretin-based therapy according to NICE recommendations in clinical practice in Wales, UK. Parameters assessed included glycated hemoglobin (HbA1c), weight, achievement of NICE treatment continuation criteria, adverse events, treatment discontinuation, and drug cost-effectiveness based on observed treatment effects. Treatment preference for a dipeptidyl peptidase-4 inhibitor (DPP-4i) or glucagon-like peptide-1 receptor agonist (GLP-1RA) was assessed prospectively.

Results: Patients (1,114) were followed-up for a median of 48 weeks (256 received liraglutide, 148 received exenatide twice daily, and 710 received a DPP-4i). Liraglutide reduced HbA1c significantly more versus exenatide or DPP-4i (both P < 0.05). Weight changes were similar for GLP-1RAs but significantly greater vs. DPP-4is (both P < 0.05). NICE treatment continuation criteria were met by 32% and 24% of liraglutide 1.2 mg- and exenatide-treated patients (≥1% HbA1c reduction, ≥3% weight loss), and 61% of DPP-4i-treated patients (≥0.5% HbA1c reduction). Life-years gained per patient were 0.12, 0.08, and 0.07, and costs per quality-adjusted life-year were £16,505, £16,648, and £20,661 for liraglutide, exenatide, and DPP-4is, respectively. More patients (62.5%) preferred the GLP-1RA profile, with these patients having higher baseline body mass index score and HbA1c values, and longer diabetes duration than those preferring the DPP-4i profile.

Conclusion: When prescribed according to NICE recommendations, incretin-based therapies are both clinically and cost-effective options, with liraglutide providing greatest HbA1c reductions. Greater body weight reductions occur with GLP-1RAs compared with DPP-4is. Patients with higher baseline HbA1c and longer diabetes duration prefer a GLP-1RA profile versus a DPP-4i.

No MeSH data available.


Related in: MedlinePlus