Trends in Clinical Characteristics and Prescribing Preferences for SGLT2 Inhibitors and GLP-1 Receptor Agonists, 2013-2018.

Abstract

There is a paucity of data evaluating recent changes in clinical and prescriber characteristics of patients initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA). U.S.-based administrative claims data (July 2013 to June 2018) were used to identify initiators of SGLT2i and GLP-1RA. Over 5 years, empagliflozin initiation (as a proportion of SGLT2i) increased by 57.1% (<i>P</i> < 0.001 for trend), while canagliflozin initiation declined by 75.1% (<i>P</i> < 0.001). Empagliflozin was the only agent within SGLT2i with an increase in the proportion of patients with myocardial infarction, stroke, or heart failure (collectively called CVD-HF) (<i>P</i> < 0.001). Liraglutide initiation (as a proportion of total GLP-1RA) declined by 32.1% (<i>P</i> < 0.001), and dulaglutide initiation increased by 34.1% (<i>P</i> < 0.001); the proportion of patients with CVD-HF increased the most in liraglutide initiators (5.1% increase; <i>P</i> < 0.001). Most prescribers were internists or endocrinologists; cardiologist prescribing remained low (<1%). For SGLT2i, shifts in preference for empagliflozin followed changes in drug labels and guidelines, while for GLP-1RA, other factors such as price or ease of administration may have led to a preference for dulaglutide over liraglutide.