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Diabetes mellitus: better glycemic control with Liraglutide compared to Exenatide


Liraglutide ( Victoza ) once daily is substantially better at controlling blood glucose in type 2 diabetes than is twice-daily Exenatide ( Byetta ).
These are the findings of the LEAD-6 study.

Liraglutide and Exenatide work by mimicking incretins, gut hormones produced after a meal that increase insulin production.
In this randomised trial, John Buse, University of North Carolina School of Medicine, Chapel Hill, and colleagues studied 464 patients, all adults with inadequately controlled type 2 diabetes on maximally tolerated doses of the diabetes drugs Metformin ( Glucophage ), sulphonylurea, or both. Of these, 233 received Liraglutide 1.8 mg once daily, while 231 received Exenatide 10 µg twice-daily.
The primary outcome was the change in glycosylated haemoglobin ( HbA1c ).

Mean baseline HbA1c for the study population was 8.2%.

Liraglutide reduced mean HbA1c by 1.12%, compared with a 0.79% reduction for patients on Exenatide.
More patients achieved an HbA1c level of less than 7.0% in the Liraglutide group ( 54% ) than in the Exenatide group ( 43% ).
Liraglutide also reduced mean fasting blood glucose levels by around two-and-a-half times more than did Exenatide.

However, Exenatide reduced blood glucose more than did Liraglutide after breakfast and dinner meals, suggesting that Liraglutide exerts more of its effects in the pre-meal or fasting period.

Both drugs promoted similar weight loss ( Liraglutide -3.2 kg vs Exenatide -2.9 kg ).

Both drugs were well tolerated, but nausea was less persistent and hypoglycaemia less common with Liraglutide than with Exenatide.

In conclusion, Liraglutide once-daily provided significantly greater improvements in glycaemic control than did Exenatide twice a day, and was generally better tolerated. The results suggest that Liraglutide might be a treatment option for type 2 diabetes, especially when weight loss and risk of hypoglycaemia are major considerations. ( Xagena )

Source: The Lancet, 2009

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