Insulin or GLP-1? A Real-World Comparative Effectiveness Analysis of Initiating Injectable Treatment Among Patients With Type 2 Diabetes Mellitus Failing Oral Antidiabetic Drugs: Pilot Data From the INITIATOR Study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 839-872-Diabetes & Obesity Management
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-857
Lin Xie1, Wenhui Wei*2, Sarah Thayer3, Lee Brekke3, Erin Buysman3, William Crown3, Michael Grabner4, Swetha Raparla4, Ralph Quimbo4, Mark Cziraky4, Onur Baser1, Wenli Hu2 and Robert M Cuddihy2
1STATinMED Research, Ann Arbor, MI, 2Sanofi US, Inc., Bridgewater, NJ, 3OptumInsight, Eden Prairie, MN, 4HealthCore, Inc., Wilmington, DE
Current consensus from the American Diabetes Association (ADA) recommends a personalized approach to treat patients with type 2 diabetes mellitus (T2DM), and also acknowledges a lack of comparative effectiveness data for decision making. A comparative effectiveness analysis of injectable T2DM treatment was conducted using data from the pilot retrospective phase of the Initiation of New Injectable Treatment Introduced after Anti-diabetic Therapy with Oral-only Regimens (INITIATOR) study.

This study combined data from two major US healthcare companies’ administrative claims databases (OptumInsight™ and HealthCore®). Adult T2DM patients with A1C ≥ 7.0%, previously on oral antidiabetic drugs (OADs) only who initiated insulin glargine disposable pen (GLA-P) or liraglutide (LIRA) in 2010, and had continuous health care coverage for ≥ 6 months before (baseline) and 9 months after (follow-up) initiation were identified. Stringent 1:1 propensity score matching was used to balance observed baseline differences between the cohorts. Treatment persistence, A1C reduction from baseline, hypoglycemic events, health care utilization, and cost outcomes were measured.

Data were included for 824 matched patients (overall; female: 41.6%; mean age: 52.5 years; number of OADs: 2.2; A1C: 8.8%); baseline characteristics were similar between the matched cohorts. During the 9-month follow-up, treatment persistence was higher for GLA-P vs LIRA (64.3% vs 51.9%, P = 0.0003). There were no significant differences in A1C reduction from baseline among patients with available data (GLA-P [n = 186] −0.82% vs LIRA [n=184] –0.92%, P = 0.5826), and hypoglycemia-related events occurred at similarly low rates in both cohorts (overall: 4.13% vs 2.67%, P = 0.2486; hospital/emergency room related: 0.24% vs 0.24%, P = 1.0000). Mean diabetes drug costs were significantly lower among GLA-P vs LIRA patients ($2330 vs $3080, P < 0.0001), mainly due to study drug costs ($895 vs $2008, P < 0.0001).

Consistent with previous findings using individual health plan data, this combined data from the pilot phase of the INITIATOR study suggest that, for patients with T2DM failing on OADs, GLA-P may be associated with higher persistence, similar A1C reduction and hypoglycemia rates, and lower diabetes drug costs compared to LIRA. These results are limited by the study’s retrospective nature and lack of weight data, and need to be confirmed by the full-phase INITIATOR study.

Disclosure: LX: Independent Contractor (including contracted research), Sanofi. WW: Employee, Sanofi. ST: Independent Contractor (including contracted research), Sanofi. LB: Independent Contractor (including contracted research), Sanofi. EB: Independent Contractor (including contracted research), Sanofi. WC: Independent Contractor (including contracted research), Sanofi. MG: Independent Contractor (including contracted research), Sanofi. SR: Independent Contractor (including contracted research), Sanofi. RQ: Independent Contractor (including contracted research), Sanofi. MC: Independent Contractor (including contracted research), Sanofi. OB: Independent Contractor (including contracted research), Sanofi. WH: Employee, Sanofi. RMC: Employee, Sanofi.

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Study funding and editorial support provided by Sanofi US, Inc.