(B-119) Real-World Utilization Patterns and Adherence to Subcutaneous and Oral Semaglutide in Adults with Type 2 Diabetes Treated in UK Primary Care

Background: Semaglutide, available as both subcutaneous (sc) injection and oral tablet, offers flexibility in managing type 2 diabetes (T2D), however, real-world evidence on the use, dosing, and adherence in clinical practice remains limited.

Objectives: To assess real-world semaglutide utilization patterns by formulation type (sc injection or oral tablet) among adults with T2D in UK primary care.

Methods: Using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, A Cegedim Database, we included adults initiating semaglutide as their first GLP-1 receptor agonist in UK primary care between 01-Jan-2018 and 30-Jun-2023. Among those with at least 1-year of follow-up in the IMRD, we described patient characteristics, and utilization patterns of once-weekly semaglutide doses stratified by formulation type.

Results: Among 5084 adults initiating semaglutide in UK primary care, 3,070 individuals (median age: 61 years; 43.6% female) had at least 1-year of follow-up in the IMRD. The majority (76.4%; n=2,345) initiated semaglutide via sc injection, predominantly at the 0.25 mg dose (89.7%; n=2,103), while 23.6% (n=725) began with the oral formulation, with the 3 mg tablet being the most common starting dose (93.0%; n=674). Discontinuation after the first prescription was higher among those initiating with tablets (15.2%) compared to injections (10.4%). By the second prescription, dose escalation was observed in 59.0% of those starting with injections (to 0.5 mg) and 58.9% of those starting with tablets (to 7 mg). By the third prescription, 22.5% of individuals on sc injections had escalated to 1 mg, while 12.1% of those on tablets progressed to 14 mg. Many stopped semaglutide before reaching the tenth prescription: 42.3% in the injection and 56.4% in the tablet group. Overall, by the tenth prescription, 52.5% of individuals who started on sc injection and 28.7% of those who started on tablets received at least one prescription for the higher doses available for T2D (1 mg or 14 mg, respectively). Cross-formulation switching was rare, with 0.9% of injection and 3.0% of tablet initiators receiving prescriptions for the other formulation.

Conclusions: Among adults with T2D in UK primary care, semaglutide discontinuation within the first year of treatment was common, particularly among those initiating therapy with the oral formulation. While most individuals followed the recommended dose escalation schedule from 0.25 mg to 0.5 mg (sc injection) or 3 mg to 7 mg (tablet) after four weeks, a small proportion escalated to the higher doses of 1 mg (injection) or 14 mg (tablet) available for T2D. These findings highlight the importance of considering patient preferences, tolerability, and adherence to dosing regimens when prescribing semaglutide.