796-P: Real-World Persistence with GLP-1 RA Treatment in Patients with Type 2 Diabetes Mellitus (T2DM) and Advanced Chronic Kidney Disease (CKD)

Abstract

Guidelines (ADA 2023 and KDIGO 2020) recommend treatment with GLP-1RAs in advanced CKD and ESRD because of their cardiovascular benefits, low risk of hypoglycemia, and potential renal benefits. GLP-1RA are vastly under-prescribed in this population, mainly due to concerns related to tolerability. We compared persistence rate with GLP-1RA vs dipeptidyl peptidase 4 inhibitors (DPP-4i) in this population. We extracted EHR data from a university health system from patients with T2DM and GFR <30 treated with either GLP-1RA or DPP-4i (2012- 2022). All charts were manually reviewed to confirm treatment start & stop date and reason for discontinuation. At the time of treatment initiation, those treated with GLP-1RA (N=149) vs DPP-4i (N=87) were younger, more likely to be female (51% vs 44%) and had a higher BMI. Only 12.7% and 9.2% of patients discontinued treatment with GLP-1RA and DPP-4i, respectively, within 180 days of initiation. The average treatment duration was 1036 and 1109 days with 34.9% and 54% having discontinued treatment at the time of data extraction. The maximum tolerated dose of GLP-1RA were comparable to that expected in patients without CKD (Table). Persistence with GLP-1RA treatment in patients with T2DM and advanced CKD is similar to DPP-4i and the vast majority tolerated the highest approved dose of GLP-1RA, confirming their tolerability in this population. Disclosure F.Sidra: None. D.Xie: None. S.Agarwal: None. I.Lingvay: Advisory Panel; Novo Nordisk A/S, Lilly Diabetes, Boehringer-Ingelheim, Sanofi, Consultant; Carmot Therapeutics, Inc., Merck Sharp & Dohme Corp., Janssen Scientific Affairs, LLC, Pfizer Inc., Intercept, Intarcia, Valeritas, TargetRWE, Shionogi, Zealand Pharma, Structure, Bayer, Research Support; Novo Nordisk A/S, Boehringer-Ingelheim.