Once-weekly exenatide as a treatment for Type 2 diabetes

Abstract

Type 2 diabetes mellitus is a progressive disease that requires pharmacologic treatment to prevent microvascular and macrovascular complications. As the disease progresses, most patients require combination therapy to achieve glucose control targets. Exenatide once weekly (EQW) is a glucagon-like peptide-1 receptor agonist approved in the United States in 2012 for use as a second-line agent to treat Type 2 diabetes mellitus. EQW has shown reductions in HbA1c and weight without causing an increased risk of hypoglycemia. This review will summarize the current clinical trial, observational study, and pharmacoeconomic analyses evaluating EQW and its impact on HbA1c and weight.

Keywords:

• clinical trial
• diabetes mellitus
• exenatide
• HbA1c
• observational study
• pharmacoeconomic evaluation
• weight

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Exenatide once weekly (EQW) is a once weekly, glucagon-like peptide-1 receptor agonists (GLP-1RA) for use as second-line treatment for Type 2 diabetes mellitus (T2DM). With robust HbA1c reduction and significant weight loss without elevating risk for hypoglycemia, EQW can help achieve key T2DM treatment goals.

• Data on EWQ real-world outcomes is limited. Additional observational research is recommended to support decisions about patient care and EQW reimbursement.

• Pharmacoeconomic modeling studies estimate that EQW is cost–effective relative to exenatide b.i.d. and insulin glargine, but insurance coverage and ability to pay should be important factors when considering addition of EQW, or any GLP-1RA, to a treatment regimen.

• Due to cost and injectable delivery, GLP-1RA, including EQW, is not likely to be the dominant choice for second-line treatment of T2DM. However, use is likely to expand into the weight-loss market in the short term with growth in this area ultimately determined by third party reimbursement for weight loss indications.