Switching to once-daily liraglutide from twice-daily exenatide further improves glycemic control in patients with type 2 diabetes using oral agents

doi:10.2337/dc09-2260

Switching to once-daily liraglutide from twice-daily exenatide further improves glycemic control in patients with type 2 diabetes using oral agents

John B. Buse, MD, PhD (jbuse{at}med.unc.edu)¹,
Giorgio Sesti, MD²,
Wolfgang E. Schmidt, MD, PhD³,
Eduard Montanya, MD, PhD⁴,
Cheng-Tao Chang, PhD⁵,
Yizhen Xu, MD, PhD⁵,
Lawrence Blonde, MD⁶ and
Julio Rosenstock, MD⁷
for the Liraglutide Effect and Action in Diabetes (LEAD)-6 Study Group

1. Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
2. Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
3. Department of Medicine I, St. Josef-Hospital, Ruhr-University Medical Faculty, Bochum, Germany
4. Hospital Universitari Bellivtge-IDIBELL, University of Barcelona, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
5. Novo Nordisk, Princeton, NJ, USA
6. Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA, USA
7. Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA

Abstract

Objective: To evaluate efficacy and safety of switching from twice-daily exenatide to once-daily liraglutide or of 40 weeks of continuous liraglutide therapy.

Research Design and Methods: When added to oral antidiabetes drugs (OADs) in a 26-week randomized trial (LEAD-6), liraglutide more effectively improved A1C, FPG, and HOMA-B than exenatide, with less persistent nausea and hypoglycemia. In this 14-week extension of LEAD-6, patients switched from twice-daily exenatide 10 μg to once-daily liraglutide 1.8 mg or continued liraglutide.

Results: Switching from exenatide to liraglutide further and significantly reduced A1C (0.32%), FPG (0.9 mmol/L), bodyweight (0.9 kg), and SBP (3.8 mmHg) with minimal minor hypoglycemia (1.30 episodes/patient-year) or nausea (3.2%). Among patients continuing liraglutide, further significant decreases in bodyweight (0.4 kg) and SBP (2.2 mmHg) occurred with 0.74 episodes/patient-year of minor hypoglycemia and 1.5% experiencing nausea.

Conclusion: Conversion from exenatide to liraglutide is well-tolerated and provides additional glycemic control and cardiometabolic benefits.