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Will longer-acting GLP-1 drugs be accepted by patients?
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The convenience of longer-acting drugs is attractive
We are very excited about the possibility of more GLP-1 drugs. There is no doubt that the convenience of longer-acting medications will be attractive. That is going to be a major boon for this class.
The early data suggest that the efficacy rates of once-weekly exenatide are better than those for the twice-a-day version. They also suggest that adverse events are lower. We are looking forward to having this available in clinical practice. It will be helpful to be able to offer a much more convenient alternative to patients who need to get to their targets and need to lose weight without changing their lifestyle. Many people in the office are going to be using the weekly over the twice-daily formulation.
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However, providers and patients often do not want to rock the boat when treatments are working. They might say, ‘Look, I am doing fine, I am tolerating this well, there is small co-pay, I really do not want to change.’
In this case the provider has to work with the patient to determine where the preferences lie. We have to talk to patients about the weekly product and ask if they would be interested in exploring it at all. There will be movement once this is available for clinical practice, but it will need to be made with caution.
June Felice Johnson, PharmD, BC-ADM-Diabetes, is an Associate Professor of Pharmacy Practice and Director of Faculty and Site Development at Drake University College of Pharmacy & Health Services.
There are two potential drawbacks to longer-acting drugs
The once-weekly or even once-daily would be attractive for most people. The less often you have to give injections, the better. From the standpoint of a patient, if you get the same or better results with a longer-acting drug and you can take the injections less frequently, that would be preferable.
That said, I see two potential drawbacks to a longer-acting drug. The first is the adverse event profile. All of these drugs have nausea. If you inject a drug once a week, the nausea may persist for quite a while. What I would like to see is a program where you start at a low weekly dose, and then once that becomes tolerable go up to a stronger weekly injection.
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The other drawback with once-weekly exenatide may also be the size of the needle. Some of these molecules are large and require a bigger needle. However, even that may be manageable, as a once-weekly injection that is slightly more painful may be better than twice a day. Again, it is a matter of convenience.
The other side of the coin, of course, is that the twice-daily exenatide has been around for a long time. People are used to using it, so it is familiar territory and it works well. The long-acting analogs will be advantageous once we have some experience with them.
Philip Levy, MD, is the Clinical Professor of Medicine at the University of Arizona College of Medicine and an Endocrine Today Editorial Board member.