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GLP-1 Agonist: the Potential New Replacement

Could medication exhibit a much desired side effect with once weekly administration?

Over the last few years, prescribing diabetic medications in the GLP-1 agonist class has become more mainstream. This can be concluded from multiple studies researching the efficacy and side effect profiles for each agent in the class. GLP-1 agonists are ideal for patients in need of glucose control, weight control, and curbing eating habits, due to the mechanism of action. These agents increase insulin release, inhibit glucagon release, slow the rate of gastric emptying, without increasing the risk of hypoglycemia

The majority of agents in this class are given once weekly, but there are also a couple that are given either daily or twice daily. Those that aren’t given weekly may pose an adherence threat in some patients who find it hard to follow dosing guidelines, thus some are better choices than others.

Francesco Zaccardi and other researchers conducted a systematic analysis of the GLP-1 agonist given once weekly, and have found pros and cons of some of the medications.  Randomized, controlled trials with over a twenty-four week follow-up time were extracted, using the drugs albiglutide, dulaglutide, exenatide extended release, semaglutide, and taspoglutide. The results were measured using each patient’s A1c or based on the individual’s safety.

With a total of 21,126 patients, 34 trials were used in the systematic review.  As expected, each agent effectively decreased patient HbA1c along with fasting glucose.  While examining weight reduction, taspoglutide 20 mg, exenatide extended release, and dulaglutide 1.5 mg yielded the most results. After examining results, scientist found notable differences in taspoglutide 20 mg and dulaglutide 0.75 mg in regards to A1c (-0.4%), with taspoglutide yielding an increase in nausea over all agents (odds ratio of 1.9-5.9).  Bydureon in comparison to Tanzeum had the biggest difference between agents with fasting glucose levels by -0.7 mmol/L.  According to an article posted in the Diabetes Care journal, agents in this class can reduce blood pressure in diabetics.  This study has found the opposite with no differences in reported blood pressures, as well as lipid levels.

Given the results from this study, once weekly  GLP-1 agonists are effective agents to help reduce patient weight, blood glucose, without an increase risk of hypoglycemia, and only require once-weekly administration.

Practice Pearls:

  • GLP-1 agonist could reduce A1c levels by 0.5-1.1%.
  • Agents in this class can decrease fasting plasma glucose.
  • Rotate injection sites to prevent injection site reactions.

Zaccardi F, Htike ZZ, Webb DR, Khunti K, Davies MJ. Benefits and Harms of Once-Weekly Glucagon-like Peptide-1 Receptor Agonist Treatments: A Systematic Review and Network Meta-analysis. Ann Intern Med. [Epub ahead of print 8 December 2015] doi:10.7326/M15-1432

Garber, A. J. “Long-Acting Glucagon-Like Peptide 1 Receptor Agonists: A Review Of Their Efficacy And Tolerability”. Diabetes Care 34.Supplement_2 (2011): S279-S284. Web. 11 Jan. 2016.

Pema, Simone et al. “Liraglutide And Obesity In Elderly: Efficacy In Fat Loss And Safety In Order To Prevent Sarcopenia. A Perspective Case Series Study”. Aging Clinical and Experimental Research (2016): n. pag. Web. Aging Clin Exp Res. 2016 Jan 9. [Epub ahead of print]

 

Researched and prepared by Samantha Ferguson, Doctor of Pharmacy Candidate University of FAMU College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE