Long-acting GLP-1RAs

Aug 7, 2020JAAPA : official journal of the American Academy of Physician Assistants

Long-lasting GLP-1 receptor drugs: effectiveness, safety, and use in managing type 2 diabetes

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Abstract

Long-acting GLP-1 receptor agonists reduce A1C levels by 1% to 1.5% in phase 3 clinical trials.

GLP-1 receptor agonists have a minimum 24-hour duration of clinically relevant effects after administration.
When used alone, these medications have a low risk of hypoglycemia due to glucose-dependent insulin release.
GLP-1 receptor agonists increase feelings of fullness, which may lead to weight loss.
All long-acting GLP-1 receptor agonists are associated with safety and do not increase cardiovascular risk.
Some GLP-1 receptor agonists have been shown to significantly reduce the risk of major cardiac adverse events in cardiovascular outcomes trials.
Weekly injectable agents provide convenience, while one long-acting option is available as a daily oral tablet.

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Over recent decades, an improved understanding of the pathophysiology of type 2 diabetes mellitus (T2DM) and glucose regulation has led to innovative research and new treatment paradigms. The discovery of the gut peptide glucagon-like peptide-1 (GLP-1) and its role in glucose regulation paved the way for the class of GLP-1 receptor agonist compounds, or GLP-1RAs. The long-acting GLP-1RAs (dulaglutide, exenatide extended-release, liraglutide, semaglutide [injectable and oral]) are classified as such based on a minimum 24-hour duration of clinically relevant effects after administration. In phase 3 clinical trial programs of long-acting GLP-1RAs, A1C typically was reduced in the range of 1% to 1.5%, with reductions close to 2% in some studies. GLP-1RAs when used alone (without sulfonylureas or insulin) have a low risk of hypoglycemia because, like endogenous GLP-1, their insulinotropic effects are glucose-dependent. In addition to local actions in the gastrointestinal (GI) tract, GLP-1RAs stimulate receptors in the central nervous system to increase satiety, resulting in weight loss. All long-acting GLP-1RAs have, at minimum, been shown to be safe and not increase cardiovascular (CV) risk and most (liraglutide, semaglutide injectable, dulaglutide, albiglutide) have been shown in CV outcomes trials (CVOTs) to significantly reduce the risk of major cardiac adverse events. The class has good tolerability overall, with generally transient GI adverse events being most common. The weekly injectable agents offer scheduling convenience and may promote treatment adherence. One long-acting GLP-1RA is available as an oral daily tablet, which may be preferable for some patients and providers.

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Long-acting GLP-1RAs

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