P193 Therapeutic inertia: Do patients get to target dose after glucagon-like peptide-1 receptor agonist (GLP-1-RA) initiation

Published Date: 23rd March 2022

Publication Authors: Cardwell J, Edon E, Westall S, McNulty S, Furlong NJ, Narayanan RP, Bujawansa S, Balafshan T, Hardy KJ

Aims
A recent primary care database study (J Rachman, Eli Lilly & Co) suggests that only about half of UK patients initiated on subcutaneous semaglutide (Ozempic) reach target maintenance dose. To assess the extent to which these data represent UK practice, we audited semaglutide dose optimisation and metabolic outcomes in our clinic.

Methods
We offer a structured, consultant-led, dietitian delivered pathway for GLP-1-RA initiation where GPs and patients are given explicit written advice about titration and target dose. We review all patients at 6 months. Using prescription data, we identified every patient initiated on subcutaneous semaglutide and audited every patient who had completed 6-month review.

Results
Of the 111 patients, 11 had a target maintenance dose of 0.5mg weekly and 100 a target maintenance dose of 1mg weekly. In 7/111 (6.3%) semaglutide was stopped for nausea; 5/111 (4.5%) had dose reduction for nausea; 1/111 (0.9%) semaglutide was stopped for hyperglycaemia. Target maintenance dose was achieved in 96/98 (98%) of the remainder. At 6-months, HbA1c had fallen by 30mmol/mol (mean ± SD): 87 ± 19 to 57 ± 16mmol/mol, p < 0.001 and weight by 6kg: 106 ± 18 to 100 ± 18 kg, p < 0.001. Some 58% of patients achieved HbA1c <58 and 45% HbA1c <53mmol/mol.

Summary
Recent findings suggesting that only about half of patients started on subcutaneous semaglutide achieve target maintenance dose as a result of therapeutic inertia are not borne out by this audit. Improvements in HbA1c and weight were highly clinically and statistically significant.

 

Cardwell, J; Edon, E; Westall, SJ; McNulty, S; Furlong, N; Narayanan, RP; Bujawansa, S; Balafshan, T; Hardy, KJ. (2022). P193 Therapeutic inertia: Do patients get to target dose after glucagon-like peptide-1 receptor agonist (GLP-1-RA) initiation. Diabetic Medicine. 39 (Suppl 1), 106-107

 

 

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