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Exenatide Once Weekly for Management of Type 2 Diabetes: A Review
Jun Inaishi1,2, Yoshifumi Saisho1
1Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Clinical Pharmacology : Advances and Applications
|April 15, 2022
Summary
Exenatide once weekly (QW) effectively manages type 2 diabetes (T2DM) but shows no cardiovascular benefit and is less effective than newer GLP-1RAs. It may be considered for T2DM in children or Parkinson's patients.
Area of Science:
- Pharmacology and Endocrinology
- Metabolic Diseases
- Clinical Therapeutics
Background:
- Exenatide, a glucagon-like peptide 1 receptor agonist (GLP-1RA), exists as twice-daily (BID) and once-weekly (QW) formulations.
- Exenatide QW demonstrated efficacy in type 2 diabetes mellitus (T2DM) management in the DURATION studies.
- GLP-1RAs are a key class for T2DM treatment, with evolving efficacy and safety profiles.
Purpose of the Study:
- To review the clinical efficacy and safety of exenatide 2 mg QW in T2DM patients.
- To discuss the current perspectives and comparative positioning of exenatide QW within the GLP-1RA class.
- To explore emerging indications for exenatide QW in T2DM and Parkinson's disease.
Main Methods:
- Review of clinical trial data, including the DURATION program and the EXSCEL cardiovascular outcome trial.
- Comparison of exenatide QW with exenatide BID, liraglutide, and semaglutide based on head-to-head trials.
- Analysis of safety data and treatment satisfaction associated with exenatide QW.
Main Results:
- Exenatide QW showed greater HbA1c reduction and treatment satisfaction compared to exenatide BID.
- Exenatide QW did not demonstrate significant cardiovascular risk reduction in the EXSCEL trial.
- Head-to-head trials indicated exenatide QW is inferior to liraglutide and semaglutide for HbA1c and weight reduction.
Conclusions:
- Exenatide QW, despite proven efficacy and safety in T2DM, may have lower priority due to lack of CV benefit and inferiority to newer agents.
- Consideration for exenatide QW is warranted for specific populations, including children with T2DM and patients with Parkinson's disease.
- The role of exenatide QW in T2DM management requires careful consideration of patient-specific factors, particularly cardiovascular risk.
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