Glycaemic and non‐glycaemic efficacy of once‐weekly GLP‐1 receptor agonists in people with type 2 diabetes

Sep 10, 2020Journal of clinical pharmacy and therapeutics

Blood sugar and other health effects of once-weekly GLP-1 drugs in type 2 diabetes

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Abstract

All once-weekly glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were superior to placebo for reductions in glycated haemoglobin and body weight.

Once-weekly GLP-1 RAs showed significant efficacy in improving and promoting weight loss.
Semaglutide subcutaneous was found to be more effective than both dulaglutide and exenatide extended-release in reducing glycated haemoglobin and body weight.
Head-to-head trials comparing once-weekly GLP-1 RAs to once-daily GLP-1 RAs yielded mixed results depending on the comparators used.
All once-weekly GLP-1 RAs were as effective as insulin when considering the effects on hypoglycaemia and body weight.
Cardiovascular outcome trials indicated that semaglutide and dulaglutide may provide benefits in reducing major adverse cardiovascular events and improving renal outcomes.

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WHAT IS KNOWN AND OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may confer a range of benefits for people with type 2 diabetes (T2D), which is reflected through their position within diabetes treatment guidelines. The objective of this narrative review is to explore the efficacy data of once-weekly (QW) GLP-1 RAs in terms of , body weight reduction, cardiovascular (CV) outcomes and potential renal protective effects to assist pharmacists and other healthcare professionals (HCPs) in treatment discussions with patients.

METHODS: This a narrative review focused on 31 clinical trials involving the Phase 3 clinical programmes of the QW GLP-1 RAs dulaglutide, exenatide extended-release (ER) and semaglutide subcutaneous (s.c.).

RESULTS AND DISCUSSION: The clinical trials were divided by their comparator arms and examined for trends. All QW GLP-1 RAs were superior to placebo for reductions in glycated haemoglobin (HbA) and body weight. Data regarding QW GLP-1 RAs versus metformin were limited, likely due to metformin's use as the first-line pharmacologic for T2D. In the robust head-to-head trials of QW versus QW GLP-1 RAs, semaglutide s.c. was superior to both dulaglutide and exenatide ER regarding HbAand body weight; however, QW versus once-daily GLP-1 RA trials had mixed results depending on the comparators. Finally, in QW GLP-1 RA versus insulin trials, all QW GLP-1 RAs were as effective as insulin, particularly when hypoglycaemia and body weight were also considered. CV outcome trials demonstrated benefits in major adverse CV events and renal outcomes for semaglutide and dulaglutide. 1c1c

WHAT IS NEW AND CONCLUSION: This review collates recently published data and previously published Phase 3 results to allow pharmacists and other HCPs to understand all of the efficacy data available and the corresponding impact on treatment guidelines. QW GLP-1 RAs are emerging as important therapeutic options for people with T2D as they offer a spectrum of benefits extending beyond glycaemic control, but it is important to be aware of their efficacy differences when prescribing and discussing them with patients.

Key numbers

−1.75%

Reduction in HbA with Semaglutide

Treatment difference in HbA reduction from trials.

−5.06 kg

Weight Loss with Semaglutide

Mean body weight reduction in trials.

HR 0.88

Major Adverse Cardiovascular Events Reduction

Hazard ratio for cardiovascular outcomes.

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Glycaemic and non‐glycaemic efficacy of once‐weekly GLP‐1 receptor agonists in people with type 2 diabetes

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