(B-057) DARWIN EU® - Trends of use of Glucagon-like peptide-1 Receptor Agonists in real-world data from five European countries

Background: Shortages of Glucagon-Like Peptide-1 receptor agonists (GLP-1 RA), a group of medicines for the treatment of diabetes and weight management, had been affecting Europe since 2022.

Objectives: To observe trends in GLP-1 RA use over the last ten years.

Methods: In this population-level drug utilisation study, we included the prescription data of the last ten years, ranged between 2013 and 2024 based on the most recent data available, from three primary care databases (the UK, Spain, and Netherlands) and two claims databases (Germany and Belgium) that are part of the DARWIN EU network. All databases were previously mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM). We estimated monthly incidence rates (IR [cases/100,000 person-years]) and point prevalence of five GLP-1 RA drugs (exenatide, liraglutide, lixisenatide, dulaglutide and semaglutide), both with their 95% confidence intervals. Calculation of IR included an additional inclusion criterion where individuals had to be followed a minimum of 365 days before they become eligible. Results were stratified by indications (diabetes mellitus type 2 [DM2] and obesity, only for incidence), age and sex.

Results: Incidence of exenatide and lixisenatide use decreased (e.g., exenatide IR in Germany fell from 10.5 [8.0 to 13.5] in July 2014 to 3.5 [1.8 to 6.2] in July 2023; lixisenatide IR in the UK fell from 18.9 [15.2 to 23.3] in July 2014 to 1.8 [0.6 to 4.2] in October 2020), whilst use of dulaglutide and semaglutide increased since they started to be observed in the databases (e.g., from no prior use in Belgium to the following IR values in Jan 2024: 177 [105 to 280] for dulaglutide use and 628 [483 to 804] for semaglutide use). Incidence of liraglutide use increased in 4 of the databases (except Germany), but the UK showed a sharp drop between June and July 2023: from 73 [63 to 86] to 27 [21 to 35]. The most common indications for starting GLP-1 RA treatment were DM2 with obesity, except for dulaglutide, exenatide and lixisenatide in Belgium, where DM2 alone was the main indication.
Similarly, prevalence of dulaglutide and semaglutide use increased over time (e.g., 0.03% for dulaglutide and 0.35% for semaglutide in Dec 2023 in the Netherlands). Prevalence of exenatide and lixisenatide use decreased, nearing 0% after June 2023. Liraglutide prevalence remained under 0.1% in all databases.

Conclusions: Dulaglutide and semaglutide use increased over the last nine and five years, respectively, while exenatide and lixisenatide use decreased in parallel. Liraglutide use variated across countries. Most GLP-1 RA users had a history of DM2, with or without obesity, aligning with EU treatment guidelines.