Eli Lilly's Trulicity Demonstrates Superior Adherence and Persistence Over Semaglutide and Exenatide in Real-World Type 2 Diabetes Study

Eli Lilly recently presented new real-world study data at the 80th Scientific Sessions of the American Diabetes Association (ADA), showing that among patients with type 2 diabetes newly initiating GLP-1 receptor agonist (RA) therapy, Trulicity (dulaglutide) demonstrated significantly higher adherence and greater persistence compared to once-weekly injections of semaglutide or exenatide (Byetta Pen).

This real-world study was a retrospective, observational study using data from the US HealthCore Integrated Research Database (HIRD) between August 2017 and June 2019. The primary objective was to compare treatment adherence and persistence over a 6-month period among patients with type 2 diabetes who initiated once-weekly GLP-1 receptor agonist (GLP-1 RA) therapy, including Trulicity (1.5 mg and 0.75 mg), semaglutide (1 mg and 0.25/0.5 mg), and exenatide.

Drug treatment persistence was assessed using Kaplan-Meier curves and Cox proportional hazards models. Trulicity users were matched 1:1 with semaglutide users (3,852 pairs) or exenatide users (1,879 pairs). The matched cohorts were balanced in terms of baseline characteristics. Study participants were aged 18 years or older and were matched based on characteristics including baseline age, sex, adapted Diabetes Complications Severity Index (aDCSI) score, and selected comorbidities.

Data show that at 6 months of treatment, patients receiving Trulicity demonstrated higher adherence and treatment persistence compared to those receiving semaglutide or exenatide. Furthermore, significantly fewer patients discontinued Trulicity therapy compared with semaglutide or exenatide.

The specific data are as follows:

Trulicity versus injectable semaglutide: (1) Adherence: 59.7% (Trulicity) vs. 42.7% (semaglutide); (2) Persistence: 143.6 days (Trulicity) vs. 129.9 days (semaglutide); (3) Treatment discontinuation: 30.8% (Trulicity) vs. 40.8% (semaglutide).

Comparison of Trulicity with exenatide: (1) Adherence: 58.1% (Trulicity) vs. 40.3% (semaglutide); (2) Persistence: 142 days (Trulicity) vs. 121.4 days (semaglutide); (3) Treatment discontinuation: 32.1% (Trulicity) vs. 49.4% (semaglutide).

Dr. Leonard Glass, Vice President of Medical Affairs at Eli Lilly, stated, “Type 2 diabetes is a progressive and heterogeneous disease, and real-world studies are essential to help us further understand patients’ experiences with this condition and its treatment. This real-world study reinforces the value of the simple, once-weekly Trulicity regimen, as well as its long-term impact not only on patients’ treatment experience but also on clinical outcomes.”

Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist (RA) administered via once-weekly injection. It has been approved, in conjunction with diet and exercise, to improve glycemic control in adult patients with type 2 diabetes. In February 2020, the U.S. FDA approved Trulicity for a new indication: to reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes who have established cardiovascular (CV) disease or multiple CV risk factors. Notably, this approval makes Trulicity the first type 2 diabetes medication approved to reduce MACE risk in both primary and secondary prevention populations.

GLP-1 RAs are a highly prominent class of diabetes medications. GLP-1 RAs are not insulin; rather, they are a novel class of insulin secretagogues. Their mechanism of action is similar to that of the endogenous hormone GLP-1, promoting glucose-dependent insulin secretion from the patient’s own pancreas during meals. They offer advantages including potent glycemic control, a lower risk of hypoglycemia, weight loss effects, and cardiovascular benefits.

Since its U.S. launch in 2014, Trulicity has become the most prescribed GLP-1 receptor agonist (GLP-1 RA). In addition to its proven glycemic efficacy and user-friendly delivery device, Trulicity is now also indicated to help reduce the risk of cardiovascular events in patients with type 2 diabetes. According to forecasts by the pharmaceutical market research firm EvaluatePharma, Trulicity’s sales will reach $7.13 billion in 2024, making it the best-selling glucose-lowering medication worldwide.

Currently, Eli Lilly is also developing higher-dose formulations of Trulicity (3 mg and 4.5 mg). Data from the Phase III AWARD-11 trial in patients with type 2 diabetes demonstrated that the higher doses (3 mg and 4.5 mg) achieved significantly greater efficacy in lowering blood glucose and reducing body weight compared to the approved dose (1.5 mg). These findings suggest that higher doses of Trulicity have the potential to offer clinicians an additional therapeutic option for managing type 2 diabetes in patients requiring further glycemic control due to the natural progression of the disease.