Glucagon-like peptide-1 receptor co-agonists for treating metabolic disease

Sep 28, 2020Molecular metabolism

Using drugs that target GLP-1 receptors to treat metabolic diseases

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GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Multiple co-agonist combinations, including tirzepatide, may provide promising clinical efficacy for metabolic disorders.

GLP-1 receptor agonists are effective for improving glycemic control and promoting weight loss.
Current GLP-1R agonists are not yet as effective as bariatric surgery in treating obesity.
Increasing doses of GLP-1R agonists, such as semaglutide, is associated with significant weight loss.
Investigational co-agonist combinations could demonstrate superior efficacy compared to GLP-1R agonists alone.
The review discusses potential peptide and non-peptide partners that could enhance treatment outcomes.

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BACKGROUND: Glucagon-like peptide-1 receptor (GLP-1R) agonists are approved to treat type 2 diabetes and obesity. They elicit robust improvements in glycemic control and weight loss, combined with cardioprotection in individuals at risk of or with pre-existing cardiovascular disease. These attributes make GLP-1 a preferred partner for next-generation therapies exhibiting improved efficacy yet retaining safety to treat diabetes, obesity, non-alcoholic steatohepatitis, and related cardiometabolic disorders. The available clinical data demonstrate that the best GLP-1R agonists are not yet competitive with bariatric surgery, emphasizing the need to further improve the efficacy of current medical therapy.

SCOPE OF REVIEW: In this article, we discuss data highlighting the physiological and pharmacological attributes of potential peptide and non-peptide partners, exemplified by amylin, glucose-dependent insulinotropic polypeptide (GIP), and steroid hormones. We review the progress, limitations, and future considerations for translating findings from preclinical experiments to competitive efficacy and safety in humans with type 2 diabetes and obesity.

MAJOR CONCLUSIONS: Multiple co-agonist combinations exhibit promising clinical efficacy, notably tirzepatide and investigational amylin combinations. Simultaneously, increasing doses of GLP-1R agonists such as semaglutide produces substantial weight loss, raising the bar for the development of new unimolecular co-agonists. Collectively, the available data suggest that new co-agonists with robust efficacy should prove superior to GLP-1R agonists alone to treat metabolic disorders.

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Glucagon-like peptide-1 receptor co-agonists for treating metabolic disease

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