Exenatide ‑ a better alternative for add-on therapy?

By Sally Robertson, B.Sc.Jun 19 2012

Twice-daily exenatide may offer advantages over the standard glimepiride in patients with Type 2 diabetes inadequately controlled by metformin, suggest findings published in The Lancet.

The study found the exenatide regimen resulted in better glycemic control than glimepiride, with patients losing rather than gaining weight.

Among 490 patients who received exenatide (5‑10 µg) twice daily and 387 who receive glimepiride (2 mg) once daily, treatment failed, requiring an alternative regimen, in 203 (41%) and 262 (54%) of the patients, respectively.

In addition, 218 (44%) of those in the exenatide group achieved a glycated hemoglobin (HbA1c) level of less than 7%, compared with 150 (31%) of those in the glimepiride group. And 140 (29%) versus 87 (18%) achieved HbA1c concentrations of 6.5% or less.

The team also report that mean body weight fell by 3.32 kg from baseline with exenatide treatment whereas it rose by 1.15 kg with glimepiride. The between-group difference in mean change in bodyweight was significant after just 4 weeks and at each time point thereafter over the 3-year study period.

"Selection of the most appropriate treatment after metformin failure is poorly established," say authors Baptist Gallwitz (University of Tubingen, Germany) and colleagues.

Their trial, including 128 centers across 14 countries, is "the longest study undertaken with a glucagon-like peptide 1 receptor agonist, and could contribute substantially to decisions in clinical practice," they write.

In an accompanying editorial, Sten Madsbad (University of Copenhagen, Denmark) says: "Physicians are divided in their opinions about the safety and effectiveness of sulfonylureas, which potentiate insulin secretion and lead to a rapid improvement in glycemic control, but result in faster deterioration of glycemic control than do metformin or a glitazone."

"Overall, this 3-year follow-up study indicates that exenatide twice daily is more effective than glimepiride in terms of several clinical parameters related to treatment of patients with Type 2 diabetes," he adds.

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