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Exenatide advantages mostly related to weight loss
2 July 2009
MedWire News: Results from a meta-analysis show that exenatide treatment achieves similar reductions in glycated hemoglobin (HbA1c) to insulin therapy, but has potential additional weight-loss benefits.
To determine the efficacy and safety of introducing exenatide compared with another oral agent or insulin in patients with inadequately controlled Type 2 diabetes, Susan Norris (Oregon Health & Science University, Portland, USA) and colleagues conducted a detailed meta-analysis of published data.
Seventeen studies (four placebo-controlled, four active controlled, and nine nonrandomized) met the meta-analysis inclusion criteria. Studies were required to have at least 12 weeks of follow-up, and report either intermediate outcomes (HbA1c, fasting plasma glucose, postprandial glucose, or weight), time to treatment failure, or health outcomes (including all-cause mortality, micro- or macrovascular complications or events, health care use, or quality of life). No studies comparing exenatide directly to an oral glucose lowering agent were identified.
Published in the journal Diabetic Medicine, the meta-analysis shows exenatide 10 µg twice daily improved HbA1c by approximately 1.0% over 30 weeks in placebo-controlled trials, with an associated weight loss of 1.0–2.5 kg.
In active-controlled trials compared with insulin, exenatide offered similar glycemic control (0.04% HbA1c reduction), but offered an advantage over insulin with respect to weight loss (3 to 6 kg loss at up to 52 weeks of follow-up).
In both placebo- and active-controlled trials nausea was the most common adverse event. Rates of hypoglycemia were similar in exenatide and insulin groups, but were higher with exenatide 10 µg twice daily compared with placebo, particularly when given with a sulfonylurea.
The authors identified significant gaps in the literature including no studies examining exenatide in adolescents or older adults with Type 2 diabetes, and a lack of cost-effectiveness data.
“Effective, active-controlled trials are needed that examine diverse populations, quality of life and treatment satisfaction outcomes, and with various glycemic control regimens as comparators,” they write.
Norris and team conclude that while weight loss may be an advantage with exenatide, long-term studies in diverse and unselected populations are needed to clarify the benefit versus harm profile of this drug.
