OBJECTIVES

Glucagon like peptide-1 receptor agonists (GLP-1 RA) are injectable drugs that serve as a second- or third-line therapeutic option for type 2 diabetes. In Taiwan, the currently available GLP-1 RA include liraglutide once daily and dulaglutide once weekly, but head-to-head comparisons of clinical effectiveness between these medications are inconclusive. To fill the research gap, we compared the changes in glycemic controls and weight changes between liraglutide and dulaglutide in clinical practice.

METHODS

This retrospective cohort study used a multi-institutional electronic medical records database covering 1.3 million individuals or 6% of the population in Taiwan. We included adults with type 2 diabetes newly initiating liraglutide or dulaglutide during 2016-2018, and followed these patients from initiation of the two agents to loss of follow-up or April 30, 2019. The study outcomes included changes in HbA1c levels and body weights after 3-month, 6-month and 12-month therapy. We performed multivariable linear regression analysis with adjustment for patients' age, sex, baseline glycemic controls and renal functions, co-morbidities and concomitant medications.

RESULTS

We included a total of 1,670 dulaglutide users and 1,719 liraglutide users with a mean age of 56.7 (SD 13.6) years, of whom 48.1% were men. Before initiation of GLP-1 RA, the mean HbA1c levels and body weights were 9.4% (SD 1.7) and 77.8 kg (SD 18.1) at baseline, respectively. After multivariable adjustment, new dulaglutide users were associated with greater HbA1c reduction (-1.0 vs. -0.7 %, p<0.01) but less body weight reduction (-0.5 vs. -0.9 kg, p=0.04) than new liraglutide users after 3-month therapy. Similar results were found after the 6-month and 12-month therapy.

CONCLUSIONS

Liraglutide and dulaglutide differ in their effectiveness for glycemic control and weight loss. Clinicians should consider patients’ baseline profiles for specific therapeutic needs when selecting GLP-1 RA.