title: Effectiveness of Liraglutide and Lixisenatide in the Treatment of Type 2 Diabetes: Real-World Evidence from The Health Improvement Network (THIN) Database in the United Kingdom.
abstract: BACKGROUND
  The glucagon-like peptide-1 receptor agonists liraglutide and lixisenatide are effective at reducing glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2DM). Although liraglutide has demonstrated superior efficacy in head-to-head clinical trials, real-world evidence of comparative effectiveness is lacking. This observational study aimed to assess the effectiveness of liraglutide versus lixisenatide in UK clinical practice.
  
  
  METHODS
  Electronic medical records from The Health Improvement Network (THIN) UK primary care database were analyzed. Patients aged ≥18 years, diagnosed with T2DM, and prescribed liraglutide or lixisenatide between 01 May 2013 and 31 December 2015 were included in the study. Adjusted linear regression models compared the difference in mean change in HbA1c, body mass index (BMI), and systolic blood pressure (SBP) after 12-month follow-up. The proportion of patients achieving glycemic control (HbA1c <6.5%, <7.0%, <7.5%); HbA1c reduction >1%; and weight reduction ≥3% within 12 months were determined. Cox proportional hazards modeling was used to evaluate the effect of treatment on time to achieving HbA1c and weight reduction targets. Healthcare resource use (HCRU) (GP, secondary care, hospitalizations) was compared using analysis of covariance.
  
  
  RESULTS
  The primary outcome was assessed in 579 liraglutide and 213 lixisenatide new users. Fully adjusted linear regression indicated that liraglutide reduced HbA1c significantly more than lixisenatide (mean treatment difference -0.30; 95% CI -0.56, -0.04; p = 0.025). Compared to lixisenatide, liraglutide recipients were 2.5 times more likely to achieve HbA1c <6.5% (p = 0.0002). Liraglutide users were also more likely to achieve HbA1c <7.0% (HR 2.10; p < 0.0001), <7.5% (HR 1.65; p < 0.0001), and >1% HbA1c reduction (HR 1.29; p = 0.0002). BMI and SBP reductions were greater for the liraglutide group but results were not significant. HCRU was comparable between treatment groups.
  
  
  CONCLUSIONS
  These results from the THIN database indicate that liraglutide treatment provided better outcomes related to glycemic control.
  
  
  BACKGROUND
  Novo Nordisk.
authors.affiliation: Chelsea and Westminster Hospital, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Feher
authors.affiliation: Novo Nordisk, West Sussex, UK. gvg@novonordisk.com.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vega-Hernandez
authors.affiliation: Novo Nordisk, Søborg, Denmark.
authors.forename: Emina
authors.initials: E
authors.lastname: Mocevic
authors.affiliation: NEMEA Centre of Excellence for Retrospective Studies, QuintilesIMS, London, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Buysse
authors.affiliation: NEMEA Centre of Excellence for Retrospective Studies, QuintilesIMS, London, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Myland
authors.affiliation: NEMEA Centre of Excellence for Retrospective Studies, QuintilesIMS, London, UK.
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Power
authors.affiliation: Novo Nordisk, Søborg, Denmark.
authors.forename: Lise L
authors.initials: LL
authors.lastname: Nystrup Husemoen
authors.affiliation: NEMEA Centre of Excellence for Retrospective Studies, QuintilesIMS, London, UK.|Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.|Danish Diabetes Academy, Odense, Denmark.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Witte
keywords: GLP-1 RA; HbA1c; Liraglutide; Lixisenatide; THIN; The Health Improvement Network; Type 2 diabetes