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Exenatide: Once Weekly Dosing or Twice Daily?

Does Bydureon once weekly show benefit in type 2 diabetic patients?…

Exenatide ER (Bydureon™) is a glucagon-like peptide-1 (GLP-1) receptor agonist that provides a continuous amount of drug over the time period of one week, allowing for weekly dosing with lower rates of nausea as compared with regular release exenatide. 

Previous literature has shown that fewer than 50% of type 2 diabetic patients achieve HbA1C of <7% over 9 months when taking insulin alone or in combination with other hypoglycemic agents.

This study examined the evidence surrounding the use of Bydureon™ in patients with type2 diabetes.

The clinical effects of weekly exenatide were compared with those of twice daily dosing of exenatide (Byetta®) utilizing clinical data from the DURATION trials. Variables examined included the drug route, dosing frequency, change in A1C%, weight change (kg), hypoglycemia, adverse GI effects, and monthly drug cost.

In the DURATION-1 trial, patients with type 2 diabetes and baseline A1c values of 8.3% on metformin, sulfonylurea therapy, or thiazolidinedione (or combination of any 2) were given either exenatide ER or exenatide twice daily (BID) for a duration of 30 weeks. It was found that patients taking the exenatide ER had a decrease in A1c of -1.9% as compared to those taking the twice daily dosage form (-1.5%), P=0.0023, with less nausea experienced by the exenatide ER group. Both groups had similar weight loss profiles. Similarly, in the DURATION-5 trial, patients with type 2 diabetes and baseline A1c values of 8.4% already taking metformin, sulfonylurea therapy, or thiazolidinediones (or combination) were randomized to either the ER or BID form of exenatide for a duration of 24 weeks.

Patients taking exenatide ER experienced a greater decrease in A1c of -1.6% (versus 0.9% for exenatide BID, P<0.0001), as well as a drop in fasting plasma glucose (FPG) of 35 mg/dL (versus 12mg/dL for exenatide BID, P=0.0008), as well as a weight reduction of 2.3kg for the ER group (versus 1.4kg for BID group, P=0.01). In conclusion, exenatide ER has shown greater efficacy and improved side effect profiles as compared to twice daily dosing of exenatide, with a level 1 evidence. Healthcare providers may consider the once weekly dosing as an option for type 2 diabetic patients who have had success with exenatide twice daily but would benefit from minimizing adverse GI side effects. Overall, exenatide ER enables this patient population to lower A1c, lessen hypoglycemia, and aid in weight reduction.

Practice Pearls:
  • Exenatide ER is a GLP-1 agonist that can be used in combination with other oral medications such as metformin, sulfonylureas, or thiazolidinediones.
  • Exenatide ER has been shown to have less GI side effects than the regular release form and is effective at reducing HbA1C levels, with reductions seen of 1.6%.
  • Patients should be educated on the proper technique for use of exenatide ER since it is a novel delivery system

Painter et al. An Evidence-Based and Practical Approach to Using Bydureon™ in Patients With Type 2 Diabetes. JABFM, 2013;26(2):203-210.