Real-World Comparative Evaluation of Clinical and Economic Outcomes of Fixed-Ratio GLP-1 Receptor Agonist and Basal Insulin Combinations

Many patients require glucagon-like peptide-1 receptor agonists (GLP-1 RA) and basal insulin for glycemic control. Only two fixed-ratio combination products are available: insulin degludec/liraglutide (iDergLira) and insulin glargine/lixisenatide (iGlarLixi). Our prior study using real-world data found that iGlarLixi was associated with fewer cardiovascular events versus iDegLira. This study sought to estimate the clinical and economic outcomes in a primary prevention cohort. Data were assessed through TriNetX (Cambridge, MA, USA), a global health research network. Two cohorts were created to assess patients with type 2 diabetes using either iDegLira or iGlarLixi. Patients with prior myocardial infarction (MI), heart failure (HF), stroke, or stage-4 or worse chronic kidney disease were excluded. The index date was defined as a prescription generated for either iGlarLixi or iDegLira after diagnosis of type 2 diabetes, and the observation window for the outcomes was set to 1,460 days. 1:1 propensity score matching was used to balance the cohort using gender, race, prandial insulin, glycated hemoglobin, and body weight. The primary clinical outcome was the composite of MI, stroke, and HF. We calculated total disutilities and cost by year. Propensity score matching resulted in two well-balanced cohorts (n = 2,805 each). The primary composite outcome occurred more frequently with iDegLira versus iGlarLixi (risk ratio = 1.87 [95% CI: 1.58, 2.22]). Disutilities and costs favored iGlarLixi versus iDegLira. Based on discounted utilities and costs, the average per-patient-year disutilities for iGlarLixi were roughly half that versus iDegLira (0.004 vs. 0.010), and total costs were roughly one-third less for iGlarLixi.In patients with type 2 diabetes, iGlarLixi was associated with a lower disutility and cost versus iDegLira. The study confirms and aligns with our prior real-world analysis of iGlarLixi versus iDegLira, though herein limited to cardiovascular primary prevention. A head-to-head clinical trial would be needed to confirm these results.