Utilization Trends of Dual GIP/GLP-1 Receptor Agonist, Newer Glucose-Lowering Medications, and Anti-Obesity Medications Among Patients With Chronic Kidney Disease With and Without Type 2 Diabetes.

RATIONALE & OBJECTIVE: Tirzepatide, a dual GIP/GLP-1 receptor agonist, has been approved for type 2 diabetes (T2D) and obesity. However, the real-world utilization of tirzepatide remains unexplored, particularly in patients with chronic kidney disease (CKD), where the prevalence of T2D and obesity is high. This study aimed to describe the utilization trends of tirzepatide, glucose-lowering medications (GLMs), and anti-obesity medications (AOMs) in patients with CKD, with and without T2D. STUDY DESIGN: A population-based, observational cohort study. SETTING & PARTICIPANTS: Patients with CKD, with and without T2D, were identified from a large US health insurance claims database (from January 1, 2022 to September 30, 2023). EXPOSURES: Tirzepatide, other GLMs, and AOMs. OUTCOMES: Medication utilization trends and patient characteristics. Any users were defined as those with prescription claims, and incident users as those with no previous dispensing within 365 days. ANALYTICAL APPROACH: Longitudinal trends were assessed by 1-month intervals from January 1, 2022 to September 30, 2023. RESULTS: Among 455,047 patients with CKD and T2D, tirzepatide any users increased to 4.8% in September 2023, while incident users rose from 0.8% to 8.6%. Sodium glucose cotransporter-2 inhibitors remained the most initiated GLM. Tirzepatide initiators had higher rates of obesity (32.5%), and morbid obesity (44.1%) when compared with other GLMs. Among 5,978 patients with CKD without diabetes, weekly semaglutide ≤2 mg was the most initiated AOM, followed by tirzepatide. Incident users of tirzepatide rose from 0.6% in June 2022 to 23.5% in September 2023. Clinical characteristics were similar between semaglutide ≤2 mg versus tirzepatide initiators. LIMITATIONS: The study period ended before tirzepatide's approval for weight management (November 2023). CONCLUSIONS: Our study indicates rapidly shifting trends in tirzepatide uptake among patients with CKD both with and without diabetes. The uptake of tirzepatide is expected to increase further. Future studies on the comparative effectiveness and safety of tirzepatide in patients with CKD are warranted.