(100) Trends in Clinical Characteristics and Prescribing Patterns for GLP-1 Receptor Agonists and GIPs, 2015–2023

Background: Since 2015, the glucagon-like peptide 1 receptor agonists (GLP-1RA) landscape has changed dramatically due to market entries and exits, new evidence supporting benefits other than glycemic control, and FDA approval for weight loss for some GLP-1RAs. There is a lack of real-word evidence describing changes in clinical and prescribing characteristics of patients initiating GLP-1RA and glucose-dependent insulinotropic polypeptide (GLP-1RA /GIP) medications.

Objectives: To describe changes in prescribing patterns and clinical characteristics in US patients initiating GLP-1RA medications from 2015-2023.

Methods: We used Aetna administrative medical and pharmacy claims data(January 2015 to October 2023) to identify adult initiators of GLP-1RA and GLP-1RA/GIP medication. A six-month lookback period was used to establish GLP-1RA initiation. The primary outcomes were GLP-1RA drug, demographics, comorbidities, and concomitant diabetes medication. Comorbidities and concomitant diabetes medication were captured +-90 days of drug initiation. Drug, indication (diabetes or weight loss), and route (injection or tablets) were captured using National Drug Codes(NDC) assigned at dispensing. Changes in means and prevalence were calculated using T-test and chi square, respectively. Expected Annual Percent Change (EAPC) was also calculated using a mixed regression model.

Results: During the 8-year study period, the percent of patients initiating on liraglutide (relative to all GLP-1RAs) decreased by 46% (P <.001) while the percent of patients initiating on semaglutide (2017 market entry) increased to 49%(P <.001)
Among patients receiving GLP1-RA therapy indicated for diabetes, the percentage of concomitant diabetes medication use fell to 64.4% by 2023, representing a 24.9% decrease overall(p <.001). The average age of GLP1-RA initiates increased by 3.5 years (P <.001) during this time and the population became more female by 10.2%(P <.001).
The prevalence of comorbidities among GLP1-RA initiates such as diabetes and chronic kidney disease decreased during this period, yet several cardiovascular comorbidities and depression became more prevalent, including heart failure(4.3% increase, p<.001), ischemic heart disease(4.0% increase, p<.001), and peripheral artery disease(3.3% increase, p<.001).

Conclusions: GLP-1RA prescribing patterns and patient characteristics have changed significantly during the 8 years following GLP1-RA approval for weight-loss. Patients taking GLP1-RA are older and have more cardiovascular comorbidities. As GLP1-RA therapy becomes more prevalent and expands to other indications, the need for real-world evidence regarding safety and effectiveness increases.