Medication adherence to injectable glucagon-like peptide-1 (GLP-1) receptor agonists dosed once-weekly versus once-daily in patients with type 2 diabetes: a meta-analysis.

Weeda, Erin R; Muraoka, Alyssa K; Brock, Matthew D; Cannon, Jessica M

BACKGROUND Suboptimal medication adherence has been associated with increased resource utilization and mortality among patients with type 2 diabetes (T2D). Glucagon like peptide-1 receptor agonists (GLP-1RAs) are becoming increasingly important in the treatment of T2D. However, medications in this class differ considerably in their dosing frequency, which may impact adherence. We sought to perform a meta-analysis to compare adherence to injectable GLP-1RAs dosed once-weekly versus once-daily inpatients with T2D. METHODS Medline and Scopus were searched from 1/2005-7/2020 using keywords and MeSH terms pertaining to adherence and GLP-1RAs. Studies of adults with T2D were included if they compared adherence (as measured by proportion of days covered [PDC]) to injectable GLP-1RAs dosed once-weekly versus once-daily. A meta-analysis of non-overlapping studies was performed to evaluate the primary outcome of non-adherence, defined as the proportion of patients with a PDC<80. RESULTS A total of 7 studies evaluating 75,159 patients (range:2,886-30,097) with T2D were included. The follow-up periods of included studies ranged from 6-12 months. Injectable GLP-1RAs dosed once-weekly were either dulaglutide, albiglutide, or exenatide extended release; while liraglutide was the injectable once-daily agent evaluated in all included studies. Upon meta-analysis, once-weekly GLP-1RA dosing was associated with an 11% lower risk of non-adherence compared to once-daily dosing (risk ratio=0.89;95%confidence interval=0.83-0.95;I2=89%). CONCLUSION Once-weekly dosing of injectable GLP-1RAs was associated with better adherence versus once-daily dosing among patients with T2D. These findings coupled with the known detrimental consequences of non-adherence suggest that dosing frequency is an important factor to consider when selecting a GLP-1RA.