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Changing exenatide dosing pattern still yields HbA1c, beta-cell benefits
Among a cohort of Japanese adults with type 2 diabetes, HbA1c and fasting plasma glucose fell and beta-cell function rose after a change from exenatide twice per day to exenatide once per week, according to findings published in the Journal of Diabetes Investigation.
“Our study showed that postprandial glycemic excursion was more effectively reduced by a short-acting GLP-1 receptor agonist,” Yoshifumi Saisho, MD, PhD, an assistant professor in the division of nephrology, endocrinology and metabolism of the department of internal medicine at Keio University School of Medicine in Tokyo, told Endocrine Today. “However, switching from a short-acting to long-acting GLP-1 receptor agonist did not increase oxidative stress and inflammation despite an increase in postprandial glycemic excursion, suggesting that a long-acting GLP-1 receptor agonist may not deteriorate CV outcomes compared with a short-acting GLP-1 receptor agonist despite greater postprandial glycemic excursion.”
Saisho and colleagues evaluated HbA1c, body weight, blood pressure, heart rate, FPG, insulin resistance and beta-cell function and hypoglycemia episodes across 24 weeks in 58 adults with type 2 diabetes (mean age, 55 years; 25.9% women) who began a regimen of exenatide once per week (Bydureon, AstraZeneca) following 3 months or more of exenatide twice per day (Byetta, AstraZeneca) at doses of 10 µg or 20 µg. At weeks 4, 8, 16 and 24, the researchers collected measurements while participants used a questionnaire to self-report episodes of hypoglycemia and treatment satisfaction.
Among all participants, the average HbA1c at baseline was 7.2% and 7% after 24 weeks of exenatide once per week (P = .01). Among participants who were on a daily regimen of 20 µg exenatide, the average HbA1c was 7.3% at baseline and 7.1% after 24 weeks (P = .04). The researchers noted that average prestudy BMI and HbA1c was greatest among those who attained at least a 0.5% decrease in HbA1c. In addition, these participants lost an average of 1.1 kg after 24 weeks, whereas the rest of the cohort gained an average of 0.4 kg (P = .02).
The average FPG level at baseline was 154 mg/dL and 142 mg/dL at 24 weeks (P = .02). The cohort had a collected mean preprandial self-monitoring blood glucose level of 142 mg/dL at baseline and 133 mg/dL at 24 weeks (P = .02). At baseline, participants reported 0.4 episodes of hypoglycemia per person-month, and at 24 weeks, the participants reported 0.04 episodes of hypoglycemia (P = .007).
“The different modes of action between short-acting and long-acting GLP-1 receptor agonists on glucose-lowering effects should be taken into account when selecting treatment options for patients with type 2 diabetes,” Saisho said. “But any drug has its advantages as well as disadvantage[s] and we stress that a patient-centered approach to select individual treatment options is still important based on the information obtained from our study.”
Conversely, participants had an average measure of the homeostasis model assessment of beta-cell function of 43.6% at baseline and 52% after 24 weeks (P = .002). In addition, the average C-peptide index measure was 2.32 at baseline and 2.66 after 24 weeks (P = .04), whereas the cohort had a collected mean postprandial SMBG level of 162 mg/dL at baseline and 187 mg/dL after 24 weeks (P < .001), as well as an average glucagon level of 139 pg/mL at baseline and 149 pg/mL after 24 weeks (P = .01).
“This study provided information on different glucose lowering profiles between short-acting and long-acting GLP-1 receptor agonists in the clinical setting, which will be useful to select an optimal treatment option for patients with type 2 diabetes,” Saisho said. “In addition, the improvement of treatment satisfaction with a long-acting GLP-1 receptor agonist is an important outcome for patient-centered diabetes care.” – by Phil Neuffer
For more information:
Yoshifumi Saisho, MD, PhD, can be reached at ysaisho@keio.jp.
Disclosures: This study was supported by funding from AstraZeneca. The authors report no relevant financial disclosures.