gms | German Medical Science

20. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

06. - 08.10.2021, digital

Prescription frequency and development of liraglutide and empagliflozin in the light of current DMP recommendations: a German real-world cohort study in type 2 diabetes mellitus patients at high cardiovascular risk

Meeting Abstract

  • Karolin Seidel - Xcenda GmbH, Hannover, Deutschland
  • Christian Jacob - Xcenda GmbH, Hannover, Deutschland
  • Daniel Schwedler - Novo Nordisk Pharma GmbH, Mainz, Deutschland
  • Jasmin Hotzy - Novo Nordisk Pharma GmbH, Mainz, Deutschland

20. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 06.-08.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc21dkvf068

doi: 10.3205/21dkvf068, urn:nbn:de:0183-21dkvf0686

Published: September 27, 2021

© 2021 Seidel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background and status of (inter)national research: Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia fostering the development of cardiovascular diseases (CVD) and/or chronic kidney disease (CKD). For the treatment of at-risk patients, empagliflozin (2017) and liraglutide (2019) are recommended in the German Disease Management Program (DMP) based on the outcomes of EMPA-REG OUTCOME and LEADER trails.

Question and objective: Aim of this study was to assess the development of liraglutide and empagliflozin treatment in T2DM patients at high cardiovascular risk considering the DMP recommendation.

Method or hypothesis: We conducted a retrospective claims data analysis using the Institute for Applied Health Research Berlin Research Database. T2DM patients with CVD and/or CKD between 01/2014 and 12/2016 were identified by ICD-10-GM codes. Revascularizations indicating CVD were assessed by OPS codes. Proportion of T2DM patients with CVD and/or CKD treated with liraglutide/empagliflozin and prescription frequency were evaluated by ATC codes. Respective patients were identified in three further periods: 01/2013–03/2016, 01/2017–09/2018 and 01/2017–12/2019 representing the cardiovascular outcome trials SUSTAIN 6 and PIONEER 6 of semaglutide and the most recent years in the database.

Results:The analysis yielded a prevalence of treated T2DM patients with manifest CVD and/or CKD between 0.7% (01/2014–12/2016) and 1.0% (01/2017–12/2019). In 01/2013–03/2016, only 1.4% of the T2DM patients at high cardiovascular risk received treatment with liraglutide/empagliflozin. The prescription frequency increased in 2016 to 2.6%, to 6.5% in the timeframe 01/2017–09/2018 and to 8.9% in 2019. Comparing the allocation of both agents, the share of empagliflozin increased considerably over time.

Discussion: Considering the German DMP recommendation, our analysis revealed an increase in the prescription frequency of both agents with the growth in empagliflozin exceeding the increase of liraglutide. Findings were consistent to the drug prescription report stating a prescription of 20.8 vs 6.0 million DDDs of liraglutide vs empagliflozin in 2015. By 2018, the prescription volume of liraglutide increased to 22.4 million DDDs while 66.9 million DDDs of empagliflozin were prescribed. This corresponds to a year-to-year growth rate of 21.6% (liraglutide) vs 45.2% (empagliflozin).

Practical implications: While the prevalence of CVD and/or CKD among T2DM patients showed only a slight increase, the real-world results indicated a notable increase of liraglutide/empagliflozin treatment in respective patients over time. However, only 8.9% of at-risk patients received the concomitant antidiabetic medication recommended in the DMP in 2019, indicating a need for further research regarding the use of SGLT2 inhibitors or GLP-1 receptor antagonists in this vulnerable patient population.

Appeal for practice (science and/or care) in one sentence: In practice, patient’s cardiovascular risk should be considered when treating T2DM as increasingly mentioned in the practice recommendation of the German Diabetes Association or the consultation version of the T2DM National Healthcare Guideline.