Increased tirzepatide use for glycemic and weight control since United States market entry

1. In this retrospective cohort study, tirzepatide dispensations were found to have increased significantly following approval in the United States among people both with and without type 2 diabetes.

2. Among persons without type 2 diabetes, semaglutide remained the most frequently dispensed weight-lowering medication.

Evidence Rating Level: 2 (Good)

Study Rundown: Obesity and type 2 diabetes mellitus (T2DM) continue to increase in prevalence, contributing to significant comorbidity and healthcare expenditures. Recent trials have shown significant efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the management of obesity and T2DM, particularly owing to its metabolic, cardiovascular, and renal benefits. These outcomes have contributed to the ongoing research and evolution of glucose- and weight-lowering pharmacotherapy, with heightened investigation of various incretin-based pathways for more effective glycemic control and weight management. Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, is the only medication of its type approved in the United States which targets multiple incretin pathways for the management of obesity and T2DM. However, evaluation of contemporary trends on the uptake of tirzepatide is lacking, and there is currently limited evidence comparing the efficacy of tirzepatide to GLP-1 RAs, such as semaglutide, on the aforementioned outcomes. Hence, this cohort study investigated the trends in the utilization of glucose-lowering medications (GLMs) and weight-lowering medications (WLMs) after regulatory approval of tirzepatide in the United States. Tirzepatide dispensations were found to have increased significantly among persons with T2DMs prescribed GLMs in the U.S. since market entry. Similar trends were observed for sodium-glucose-cotransporter-2 (SGLT2) inhibitors and GLP-1 RAs, while dispensations of other GLMs such as metformin and sulfonylureas declined. Among those without T2DM prescribed WLMs, tirzepatide and semaglutide dispensations also increased significantly during this period with concomitant decreases in usage of phentermine and liraglutide. Overall, tirzepatide uptake was more rapid and sustained compared to other medications during their post-approval periods. The study results were limited by a lack of generalizability to adults without health insurance in the U.S. and those living in other countries.

Click to read the study in AIM

Relevant Reading: Dual and triple incretin-based co-agonists: novel therapeutics for obesity and diabetes

In-Depth [retrospective cohort]: This retrospective cohort study investigated the trends in medication dispensations for GLMs and WLMs following the approval of tirzepatide in the United States. Nationwide claims data from the Clinformatics Data Mart Database, Medicare supplemental insurance plans, and employer-sponsored plans were used to identify 2 separate cohorts between January 1, 2021 and December 31, 2023: adults aged 18 years and over with a diagnosis of T2DM who had pharmacy dispensing claims for a GLM, and adults without a diagnosis of T2DM who had a dispensing claim for a WLM. Overall, 1,830,876 adults with T2DM and any GLM use, and 1,279,544 adults with T2DM and incident GLM use were identified. Tirzepatide was initiated in 90,260 (4%) of these patients. Following its approval, use of tirzepatide markedly increased among adults with T2DM prescribed GLMs, reaching 12.3% of all GLM use by December 2023. Significant increases in uptake were also observed during this period for SGLT2 inhibitors (14.5% to 24.4%) and GLP-1 RAs (19.5% to 28.5%). Metformin and insulin were the most used GLMs, but use of these agents declined during this period. Among adults without T2DM, 92,314 adults had any use of WLMs, and 90,754 adults had incident use of WLMs. Tirzepatide was initiated in 17,143 (16.1%) of these patients. Any use of tirzepatide markedly increased from 0.0% to 40.6% among adults without T2DM prescribed WLMs, and semaglutide use also increased from 0.0% to 32.2% upon market entry. In summary, this study demonstrated rapidly increased tirzepatide uptake for glycemic and weight control since its regulatory approval, highlighting the dynamic landscape of prescribing patterns for GLMs and WLMs in the U.S.

Image: PD

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