title: Glucagon-like Peptide-1 receptor agonist treatment patterns among type 2 diabetes patients in six European countries.
abstract: BACKGROUND
  The objective of this study was to evaluate real-world treatment patterns of type 2 diabetes (T2D) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Germany (GE), the United Kingdom (UK), France (FR), the Netherlands (NE), Belgium (BE), and Sweden (SE).
  
  
  METHODS
  Adult T2D patients initiating exenatide twice daily (exBID), liraglutide once daily (LIRA) or exenatide once weekly (exQW) were identified using the IMS LifeLink™ (IMS Health, Danbury, CT, USA): Electronic Medical Records (EMR; GE/UK/FR) and IMS LifeLink™: longitudinal prescriptions (LRx; NE/BE/GE/UK) databases, and national health register data (SE), between 2010 and 2012. Therapy initiation date was termed 'index date'. Eligible patients had ≥180-day pre- and variable follow-up (minimum ≥360-day post-index exBID and LIRA, ≥180-day post-index exQW). Treatment modification and persistence were evaluated over 180 days. Kaplan-Meier (KM) survival curves and Cox proportional hazards models (PHMs; EMR databases only) evaluated stopping of the index therapy (measured as first of discontinuation or switch).
  
  
  RESULTS
  30,206 exBID, 5,401 exQW, and 52,155 LIRA patients were included in the analysis (46.0-66.9% male; mean age range 55.4-59.3 years). Mean follow-up was 20.3-27.4 months for exBID and LIRA, and 7.6-13.9 months for exQW. Across the databases, the proportion experiencing a treatment modification at 180 days was highest among exBID (37.6-81.7%) compared to LIRA (36.8-56.6%) and exQW (32.3-47.7%). The proportion persistent at 180 days was lowest among exBID patients (46.8-73.5%) compared to LIRA (50.6-80.1%) or exQW (57.5-74.6%). In the KM analyses, LIRA patients had a lower proportion stopping therapy at all time points compared to exBID patients, across the databases. In the Cox PHMs, LIRA was associated with a significantly lower risk of stopping compared to exBID; in GE, exQW was associated with a lower risk compared to exBID and LIRA.
  
  
  CONCLUSIONS
  Treatment patterns varied among GLP-1 RA patients, with persistence highest among either LIRA or exQW across countries, and lowest among exBID. Longer-term data would be useful, particularly given limited exQW follow-up due to more recent launch.
authors.affiliation: Health Economics and Outcomes Research Real-World Evidence Solutions, IMS Health, Fairfax, VA, USA, vdivino@us.imshealth.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Divino
authors.forename: Mitch
authors.initials: M
authors.lastname: DeKoven
authors.forename: Shawn
authors.initials: S
authors.lastname: Hallinan
authors.forename: Nebibe
authors.initials: N
authors.lastname: Varol
authors.forename: Sara Bruce
authors.initials: SB
authors.lastname: Wirta
authors.forename: Won Chan
authors.initials: WC
authors.lastname: Lee
authors.forename: Matthew
authors.initials: M
authors.lastname: Reaney