Comparison of low-dose liraglutide use versus other GLP-1 receptor agonists in patients without type 2 diabetes

The objective was to compare the use of low-dose liraglutide (LD-L) (Victoza) to the other glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients without a type 2 diabetes (T2D) diagnosis in the post approval period for high-dose liraglutide (HD-L) (Saxenda), which is not indicated for T2D. This was a retrospective, repeated cross-sectional, cohort study. Adult patients with T2D with more than 1 prescription for a GLP-1 RA in the Optum Humedica database between December 2014 and March 2016 were included. The proportions of patients without a T2D diagnosis who were prescribed L-DL versus the other GLP-1 RAs and within each cohort were computed. Logistic regression models estimated the predictive value of either treatment in those without a T2D diagnosis, controlling for multiple factors. To supplement these findings, administrative claims data were extracted from the Truven Health MarketScan database. Analyses identified 11,245 patients prescribed LD-L and 4134 patients prescribed other GLP-1 RAs. For the entire study period, Humedica data revealed that patients without T2D accounted for 2.7% of the GLP-1 RA cohort and 17.5% of the LD-L cohort. Multivariable logistic regression analyses identified that patients receiving LD-L were more than 6 times likely to have no indication of T2D relative to patients taking other GLP-1 RAs. Claims data from MarketScan corroborated the Humedica results. In patients without a T2D diagnosis, LD-L use was significantly greater than that with other GLP-1 RAs within 6 months after approval of HD-L; differences persisted until the end of the study. Increased payer scrutiny of appropriate LD-L use is warranted.