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      Comparative effectiveness of exenatide once‐weekly versus liraglutide in routine clinical practice: A retrospective multicentre study and meta‐analysis of observational studies

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          Abstract

          In this study, we retrospectively compared the effectiveness of exenatide once‐weekly (ExeOW) versus liraglutide in non‐insulin treated patients with type 2 diabetes followed under routine care. We also present a meta‐analysis of similar observational studies available in the literature. In our multicentre retrospective study, patients initiating ExeOW ( n = 204) or liraglutide ( n = 410) had similar baseline clinical characteristics. Change in HbA1c at 6 months was superimposable in the two groups (−0.7% ± 1.0%), and changes in body weight were also similar (ExeOW ‐2.2 ± 3.7 kg; liraglutide −2.5 ± 4.3 kg; p = 0.457). Discontinuation rates were numerically but not significantly lower for ExeOW versus liraglutide. Pooling these data with those of observational studies available in the literature yielded superimposable effects between the two groups for the change in HbA1c and body weight, with a higher risk of discontinuation (mainly based on pharmacy refill rates) for ExeOW. We conclude that, in patients under routine care, initiation of ExeOW provides similar benefits on HbA1c and body weight as initiation of liraglutide. These data help view the results of randomized controlled trials from the perspective of their application in routine clinical practice.

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          Most cited references15

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          Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

          The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown.
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            Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

            Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke.
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              Glucagon-Like Peptide-1 Receptor Agonist Treatment Patterns Among Type 2 Diabetes Patients in Six European Countries

              Introduction 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. Conclusion 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. Electronic supplementary material The online version of this article (doi:10.1007/s13300-014-0087-6) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                gianpaolo.fadini@unipd.it
                Journal
                Diabetes Obes Metab
                Diabetes Obes Metab
                10.1111/(ISSN)1463-1326
                DOM
                Diabetes, Obesity & Metabolism
                Blackwell Publishing Ltd (Oxford, UK )
                1462-8902
                1463-1326
                22 January 2019
                May 2019
                : 21
                : 5 ( doiID: 10.1111/dom.2019.21.issue-5 )
                : 1255-1260
                Affiliations
                [ 1 ] Department of Medicine University of Padova Padova Italy
                [ 2 ] Diabetology Service Azienda Sanitaria dell'Alto Adige Bolzano Italy
                [ 3 ] Fatebenefratelli Hospital Endocrinology and Diabetology Milan Italy
                [ 4 ] Internal Medicine and Diabetology Cittadella Italy
                Author notes
                [*] [* ] Correspondence

                Gian Paolo Fadini, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.

                Email: gianpaolo.fadini@ 123456unipd.it

                [†]

                “For the composition of the DARWIN‐T2D Network, please refer to the Acknowledgments.”

                Author information
                https://orcid.org/0000-0002-6510-2097
                https://orcid.org/0000-0002-1177-0516
                Article
                DOM13623
                10.1111/dom.13623
                6590315
                30578607
                9e6857e8-7a3b-440e-8688-9595baceba7b
                © 2018 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 06 November 2018
                : 14 December 2018
                : 14 December 2018
                Page count
                Figures: 2, Tables: 0, Pages: 6, Words: 4074
                Funding
                Funded by: Italian Diabetes Society, through a grant from AstraZeneca
                Categories
                Brief Report
                Brief Reports
                Custom metadata
                2.0
                dom13623
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

                Endocrinology & Diabetes
                antidiabetic drug,cohort study,exenatide,liraglutide,type 2 diabetes
                Endocrinology & Diabetes
                antidiabetic drug, cohort study, exenatide, liraglutide, type 2 diabetes

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