Discontinuation and reinitiation of SGLT-2 inhibitors and GLP-1R agonists in patients with type 2 diabetes: a nationwide study from 2013 to 2021

Mariam Elmegaard Malik; Alexander Christian Falkentoft; Jesper Jensen; Deewa Zahir; Saaima Parveen; Amna Alhakak; Charlotte Andersson; Mark C Petrie; Naveed Sattar; John J V McMurray; Lars Køber; Morten Schou

doi:10.1016/j.lanepe.2023.100617

Discontinuation and reinitiation of SGLT-2 inhibitors and GLP-1R agonists in patients with type 2 diabetes: a nationwide study from 2013 to 2021

Lancet Reg Health Eur. 2023 Mar 17:29:100617. doi: 10.1016/j.lanepe.2023.100617. eCollection 2023 Jun.

Authors

Affiliations

¹ Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark.
² Department of Cardiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
³ Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
⁴ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
⁶ Department of Clinical Medicine, University of Copenhagen, Denmark.

Abstract

Background: Small observational studies have observed poor persistency to sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucacon-like-peptide-1-receptor agonists (GLP1-RA), contrary to what has been reported in clinical trials. Therefore, we investigated the risk of discontinuing SGLT2-is and GLP1-RAs in patients with type 2 diabetes (T2D) in a nationwide population.

Methods: From Danish nationwide registers, all first-time users of SGLT2-is and GLP1-RAs from 2013 to 2021 were identified. Adherence over the first year of therapy, the five-year risk of discontinuing therapy for the first time and the subsequent one-year probability of reinitiating therapy, was assessed. The Aalen-Johansen estimator was used to account for censoring and competing risks and multivariable Cox regression models were used to identify covariates associated with discontinuation.

Findings: A total of 77,745 first-time users of SGLT2-is (64% male, median age 64 [interquartile range 56-72]) and 56,037 first-time users of GLP1-RAs (56% male, median age 61 [53-70]) were included. The absolute five-year risk of discontinuing therapy was 56% (95% CI: 55-57) and 45% (45-46) for SGLT2-i- and GLP1-RA users, respectively, with a significantly decreased risk over the period studied. The subsequent one-year probability of reinitiating therapy was 24% (95% CI: 24-25) for initial SGLT2-i users and 26% (25-27) for GLP1-RA users.

Interpretation: Approximately half of the users of SGLT2-is and GLP1-RAs discontinued therapy within five years, respectively. However, a large proportion of these patients reinitiated therapy during the following year. Further insight into the reasons for discontinuation and initiatives to reduce the time to reinitiation in eligible patients are warranted.

Funding: The work was funded by an unrestricted research grant from 'Department of Cardiology, Herlev and Gentofte University Hospital'.

Keywords: Cardiovascular disease; Epidemiology; Pharmacotherapy; Type 2 diabetes.