While emerging evidence shows cardiovascular (CV) benefits associated with use of specific glucagon-like peptide-1 (GLP-1) agonists, there is limited data on how outcomes compare between agents in the same drug class. This retrospective cohort study compared once-weekly dulaglutide and once-daily liraglutide on CV outcomes, treatment persistence/discontinuation, healthcare utilization and costs. Using administrative claims data from a large commercial and Medicare Advantage Prescription Drug health plan, new users of liraglutide or dulaglutide from January 2015 to June 2017 were identified. Eligible patients were 19-89 years, with at least 12 months of continuous enrollment pre- and post-index date (i.e., date of first new prescription). Patients who had prescription claims for other GLP-1 agonists were excluded. Propensity score matching (1:1) resulted in 2,245 patients in each treatment arm. The risk of primary composite CV outcome (myocardial infarction [MI] or stroke or mortality) and secondary CV outcome (heart failure [HF] or mortality) was similar across treatment groups, but patients indexed to dulaglutide were less likely to encounter a MI (relative risk [RR] 0.80, P=0.028) or HF (RR 0.81, P=0.001) event. Treatment discontinuation was lower in patients who used dulaglutide vs. liraglutide (57.8% vs. 63.2%, P<0.0001; hazard ratio 0.85, 95% confidence interval 0.79-0.92). The average per-person per-month pharmacy cost was higher for dulaglutide compared to the liraglutide cohort ($1,027 vs. 954, P=0.047). Total and medical costs, inpatient hospitalization stays, emergency department visits and outpatient service visits were similar across cohorts. Despite a lack of significant effect on the study’s composite CV outcomes, this real-world study showed longer treatment persistence with the use of dulaglutide that may be associated with lower MI and HF events. Findings may be useful to providers, especially in the treatment of patients who prefer once-weekly versus once-daily subcutaneous injection.
