Abstract
IntroductionExenatide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA), approved for treatment of type 2 diabetes mellitus (T2DM). There is limited direct evidence comparing the efficacy and tolerability of exenatide 2 mg once weekly (QW) to other GLP-1 RAs. A network meta-analysis (NMA) was conducted to estimate the relative efficacy and tolerability of exenatide QW versus other GLP-1 RAs for the treatment of adults with T2DM inadequately controlled on metformin monotherapy.MethodsA systematic literature review was conducted to identify randomized controlled trials (RCTs) that investigated GLP-1 RAs (albiglutide, dulaglutide, exenatide, liraglutide, and lixisenatide) at approved doses in the United States/Europe, added on to metformin only and of 24 ± 6 weeks treatment duration. A Bayesian NMA was conducted.ResultsFourteen RCTs were included in the NMA. Exenatide QW obtained a statistically significant reduction in glycated hemoglobin (HbA1c) relative to lixisenatide 20 µg once daily. No other comparisons of exenatide QW to other GLP-1 RAs were statistically significant for change in HbA1c. No statistically significant differences in change in weight, systolic blood pressure, risk of nausea or discontinuation due to adverse events were observed for exenatide QW versus other GLP-1 RAs.ConclusionExenatide QW demonstrated similar effectiveness and tolerability compared to other GLP-1 RAs, for the treatment of T2DM in adults inadequately controlled on metformin alone.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-016-0155-1) contains supplementary material, which is available to authorized users.
Highlights
Exenatide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA), approved for treatment of type 2 diabetes mellitus (T2DM)
Exenatide QW demonstrated similar effectiveness and tolerability compared to other GLP-1 RAs, for the treatment of T2DM in adults inadequately controlled on metformin alone
The results of this study suggest that exenatide QW has a similar effectiveness and tolerability profile compared to other members of its class, for the treatment of adults with T2DM inadequately controlled on metformin monotherapy, with some evidence of improved HbA1c control over lixisenatide, and, though not significant, trends toward improvement in systolic blood pressure (SBP) and reduced risk of nausea against all non-exenatide GLP-1 RAs
Summary
Exenatide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA), approved for treatment of type 2 diabetes mellitus (T2DM). Achieving and maintaining glycemic control is the primary goal in the management of type 2 diabetes mellitus (T2DM). Therapy is initiated with metformin, and other agents are added to the treatment regimen as necessary, to achieve the desired level of glycemic control [1]. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of glucose-lowering agents used in the treatment of T2DM. Exenatide is a GLP-1 RA approved for the management of glycemic control among individuals with T2DM and is currently marketed in two formulations: a solution for twice-daily injection providing either 5 or 10 lg of exenatide [exenatide twice daily (BID)] and a prolonged-release once weekly (QW) injection that provides 2 mg of exenatide (exenatide QW). Other GLP-1 RAs administered QW that have since been developed include albiglutide and dulaglutide, whereas liraglutide and lixisenatide are administered once daily (QD)
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