GLP-1 receptor agonist portfolio offers options for most adults with type 2 diabetes

BOSTON — Among the variety of GLP-1 receptor agonists approved for treatment of type 2 diabetes, each has traits that benefit some users more than others, allowing many adults with diabetes to take advantage of this medication class, according to a presenter at the Cardiometabolic Health Congress.

“These agents are different from each other in a variety of ways. We have short-acting and we have long-acting. We have some that are exendin-4 based and some that are GLP-1 based. Some of these are administered differently than others,” John B. Buse, PhD, MD, chief of the division of endocrinology and executive associate dean of clinical research at the University of North Carolina School of Medicine, said during his presentation.

That is just the beginning of their differences that make these agents appropriate for a broad group of patients, Buse said.

The recent consensus report from the American Diabetes Association and the European Association for the Study of Diabetes recommended use of SGLT2 inhibitors or GLP-1 receptor agonists with proven CVD benefit for adults with type 2 diabetes who have established atherosclerotic cardiovascular disease.

The same report concluded that for patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists are the preferred choice to insulin, Buse said.

“Ozempic [semaglutide, Novo Nordisk] is the most powerful. Trulicity [dulaglutide, Eli Lilly] is the easiest, most patient-friendly. Victoza [liraglutide, Novo Nordisk] is the best validated to prevent death, myocardial infarction and stroke. Bydureon [extended-release exenatide, AstraZeneca] arguably is the least likely to cause gastrointestinal side effects,” Buse told Healio. Novel therapies under development, such as oral semaglutide (Novo Nordisk) and exenatide delivered subcutaneously through an osmotic mini-pump (Intarcia Therapeutics), have the potential to expand the GLP-1 landscape further, offering even more options for drug delivery.

“The major considerations clinicians should have when deciding which GLP-1 receptor agonist to recommend is efficacy, safety, tolerability and adherence,” Buse said during his presentation.

“Persistence in treatment has some extremely complicated dynamics, whether they be patient-provider expectations and experiences, marketing, the dynamic between insurance companies, pharmacy benefit managers and formulary, and the media,” he said, noting that real-world evidence suggests there is a very important need for clinicians to engage in shared decision-making with their patients. – by Janel Miller

Reference: Buse JB. How many GLP-1 RAs do we need and why? Presented at: Cardiometabolic Health Congress; Oct. 24-27, 2018; Boston.

Disclosure: Buse report he is a consultant for Neurimmune AG; provides research support for Novo Nordisk, Sanofi and vTv Therapeutics; holds stock options in Mellitus Health, PhaseBio Pharmaceuticals and Stability Health; and is an advisor for Adocia, AstraZeneca, Dance Biopharm, Eli Lilly, MannKind, NovaTarg, Novo Nordisk, Senseonics, vTv Therapeutics and Zafgen.