Incretin incrementals

At the 2014 American Diabetes Association meeting, there were many presentations on GLP-1RA injectable treatments.

Data were presented on use of liraglutide in moderate renal failure (eGFR 30-60 mL/min: stage 3 chronic kidney). In keeping with its known routes of metabolism and elimination, there were no adverse effects on renal function, nor reduction in efficacy.

Lixisenatide was effective irrespective of the starting beta-cell function of patients (assessed by HOMA-b index) and shown to have less impact on pulse than liraglutide, although this may well reflect its shorter duration of effect.

Results were presented on two new once weekly GLP-1 injectable therapies. The HARMONY trial programme assessing albiglutide shows it to be well tolerated although interestingly the main GI side-effect was diarrheoa (rather than nausea/vomiting). Once weekly dulogletide showed non-inferiority to liraglutide in terms of HbA1c reduction (the first GLP-1RA to achieve this) but didn’t achieve the same weight reduction.

Perhaps the least incremental of advances was effective lowering of HbA1c in poorly controlled patients by exenatide administered via the ITCA650 implantable mini-pump, a once yearly treatment….

Professor Steve Bain