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Liraglutida una vez al día versus exenatida dos veces al día para la diabetes tipo 2: un ensayo aleatorizado de 26
John B Buse1, Julio Rosenstock, Giorgio Sesti
1Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. jbuse@med.unc.edu
Lancet (London, England)
|June 12, 2009
Resumen
La liraglutida mejoró significativamente el control glucémico y promovió la pérdida de peso en pacientes con diabetes tipo 2 de manera más efectiva que la exenatida. La liraglutida también fue mejor tolerada, con menos náuseas e hipoglucemia.
Área de la Ciencia:
- Endocrinología Endocrinología.
- Farmacología Farmacología.
- Enfermedades Metabólicas Las enfermedades metabólicas.
Sus antecedentes:
- Los agonistas de los receptores del péptido-1 parecido al glucagón (GLP-1) ofrecen una acción dependiente de la glucosa y beneficios de pérdida de peso, lo que los distingue de otros medicamentos antihiperglicémicos.
- La liraglutida, un análogo humano de la GLP-1, y la exenatida, un agonista basado en la exendina, representan opciones terapéuticas clave en esta clase.
Objetivo del estudio:
- Para comparar la eficacia y seguridad de la liraglutida frente a la exenatida en adultos con diabetes tipo 2 inadecuadamente controlada por metformina, sulfonilurea o ambas.
- Para evaluar las diferencias en el control glucémico, los cambios de peso y los perfiles de eventos adversos entre los dos agonistas de los receptores GLP-1.
Principales métodos:
- Un estudio multinacional abierto de 26 semanas en el que participaron 464 adultos con diabetes tipo 2.
- Los participantes recibieron liraglutida 1,8 mg una vez al día o exenatida 10 mcg dos veces al día como terapia adicional.
- El resultado primario fue el cambio en la hemoglobina glicosilada (HbA1c); se empleó el análisis de intención de tratar.
Principales resultados:
- La liraglutida demostró una reducción significativamente mayor en HbA1c en comparación con la exenatida (-1,12% frente a -0,79%, p<0,0001).
- Una mayor proporción de pacientes logró HbA1c <7% con liraglutida (54% frente a 43%, p=0,0015).
- La liraglutida también condujo a mayores reducciones en la glucosa plasmática en ayunas y se asoció con náuseas menos persistentes y hipoglucemia menor menos frecuente.
Conclusiones:
- La liraglutida una vez al día ofrece un control glucémico superior y una mejor tolerabilidad en comparación con la exenatida dos veces al día en el manejo de la diabetes tipo 2.
- La liraglutida presenta una valiosa opción de tratamiento, especialmente para pacientes en los que la pérdida de peso y la reducción del riesgo de hipoglucemia son consideraciones importantes.
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