Exenatide once-weekly injection for the treatment of type 2 diabetes in Chinese patients: current perspectives

Figures & data

Table 1 Glucose-lowering effect and weight loss on exenatide QW versus other hypoglycemic drugs

Studies	Duration(weeks)	Interventions compared	HbA1c(%)	HbA1c≤7 (%)	HbA1c ≤6.5 (%)	FG (mmol/L)	Bodyweight (kg)	Hypoglycemia (%)
Drucker et al^Citation57	30	Exenatide QW 2 mg versus exenatide 10 µg BID	−1.9	77	49	−2.3	−3.7	No sulfonylurea background:
			−1.5	61	21	−1.4	−3.6	major: 0 versus 0 minor: 0 versus 1 Sulfonylurea background: major: 0 versus 0 minor: 14.5 versus 15.4
Buse et al^Citation68	52	Exenatide QW 2 mg versus exenatide 10 µg	−2.0	71	54	−2.4	−4.1	N/A
		BID→QW 2 mg	−2.0	71	53	−2.6	−4.5	N/A
Diamant et al^Citation67	26	Exenatide QW 2 mg versus insulin glargine 10	−1.5	60	35	−2.1	−2.6	Minor: 8 versus 26
		IU QD (starting dose)	−1.3	48	23	−2.8	+1.4	Symptomatic: 13 versus 31
Bergenstalet al^Citation64	26	Exenatide QW 2 mg versus sitagliptin	−1.5	60	40	−1.8	−2.3	Minor: 1.0 versus
		100 mg QD, pioglitazone 45 mg QD	−0.9	35	20	−0.9	−0.8	3.0 versus
			−1.2	52	30	−1.5	+2.8	1.0
Blevins et al^Citation66	24	Exenatide QW 2 mg versus exenatide 5 µg	−1.6	41.1	58.1	−1.94	−2.3	No major
		BID→10 µg BID	−0.9	16.3	30.1	−0.66	−1.4	Sulfonylurea background: minor: 6.7 versus 5.4
Inagaki et al^Citation65	26	Exenatide QW 2 mg versus insulin 4 IU QD	−1.11	42.2	20.6	−2.40	−1.67	Minor: 0.5 versus 1.9
			−0.68	21.0	4.2	−2.39	+0.34	Symptomatic: 9.3 versus 19 Overall hypoglycemia: 9.8 versus 20.8
Diamant et al^Citation70	84	Exenatide QW 2 mg versus insulin 10 IU QD	−1.2	44.6	31.3	−2.36	−2.1	Metformin background:
			−1.0	36.8	20.2	−2.97	+2.4	minor: 8 versus 32 symptomatic: 12 versus 40 metformin plus sulfonylurea background: minor: 24 versus 54 symptomatic: 36 versus 56
Russell-Jones et al^Citation32	26	Exenatide QW 2 mg versus metformin 2000 mg QD, sitagliptin 100 mg QD, pioglitazone 45 mg QD	−1.53	63	49	−2.3	−2.0	N/A
			−1.48	55	36	−2.0	−2.0	N/A
			−1.63	43	26	−1.1	−0.8	N/A
			−1.48	61	42	−2.6	+1.5	N/A
Ji et al^Citation58	26	Exenatide QW 2 mg versus Exenatide 5 µg	−1.43	46.7	26.0	−2.25	−1.63	Sulfonylurea background:
		BID→10 µg BID	−1.12	35.7	15.5	−1.33	−2.45	minor: 6.8 versus 12 symptomatic: 19.7 versus 26.2 No sulfonylurea background: minor: 1.3 versus 1.4 symptomatic: 5.3 versus 11.3
Buse et al^Citation73	26	Exenatide QW 2 mg versus liraglutide 1.8 mg QD	−1.28	53	N/A	−1.76	−2.68	N/A
			−1.48	60	N/A	−2.12	−3.57	N/A
Diamant et al^Citation49	156	Exenatide QW 2 mg versus insulin 10 IU/QD (starting dose)	−1.0	48	28	−1.73	−2.49	N/A
			−0.81	38	18	−2.65	+2.01	N/A

Notes: All the data are shown as the least squares mean (standard error); → change one antidiabetic medication to the latter one; major indicates a major hypoglycemic event; minor indicates a minor hypoglycemic event.

Abbreviations: HbA1c, glycated hemoglobin; FG, fasting glucose; QW, once weekly; BID, twice daily; QD, once daily; IU, International Units; N/A, not available.

Table 2 Effect of exenatide QW on blood lipids and blood pressure versus effects of other hypoglycemic drugs

References	Duration (weeks)	Interventions compared	TC (mmol/L)	HDL-C (mmol/L)	LDL-C (mmol/L)	TG (mmol/L)	SBP (mmHg)	DBP (mmHg)
Drucker et al^Citation57	30	Exenatide QW 2 mg versus exenatide 10 µg BID	−0.31	−0.02	−0.13	−0.03	−4.7	−1.7
			−0.10	−0.03	+0.03	−0.03	−3.4	−1.7
Diamant et al^Citation67	26	Exenatide QW 2 mg versus insulin glargine 10 IU QD (starting dose)	−0.12	0.00	−0.05	N/A	−3	−1
			−0.04	0.01	+0.04	N/A	−1	−1
Buse et al^Citation68	52	Exenatide QW 2 mg versus exenatide 10 µg BID→QW 2 mg	−0.25	−0.02	−0.09	−0.27	−6.2	−2.8
			−0.23	−0.04	−0.07	−0.22	−3.8	−1.8
Bergenstal et al^Citation64	26	Exenatide QW 2 mg versus sitagliptin 100 mg QD, pioglitazone 45 mg QD	−0.02	+0.05	−0.03	−0.10	−3.75	No difference
			+0.07	+0.05	+0.04	−0.10	+0.15
			+0.16	+0.15	+0.04	−0.35	−1.25
Blevins et al^Citation66	24	Exenatide QW 2 mg versus exenatide 5 µg BID→10 µg BID	−0.40	0.00	−0.17	+0.94	−1.2	+0.2
			+0.02	+0.03	+0.07	+0.99	−2.9	−0.1
Inagaki et al^Citation65	26	Exenatide QW 2 mg versus insulin 4 IU QD	−1.67	−0.52	−1.41	1.02	N/A	N/A
			−1.67	−0.51	−1.42	1.02	N/A	N/A
Ji et al^Citation58	26	Exenatide QW 2 mg versus exenatide 5 µg BID→10 µg BID	−0.24	−0.003	−0.19	+0.01	−5.41	−1.62
			−0.21	−0.012	−0.21	+0.01	−5.38	−2.26
Buse et al^Citation73	26	Exenatide QW 2 mg versus liraglutide 1.8 mg QD	−0.06	+0.02	−0.05	N/A	−2.48	−0.49
			−0.15	+0.02	−0.09	N/A	−3.45	−0.51
Diamant et al^Citation49	156	Exenatide QW 2 mg versus insulin 10 IU QD (starting dose)	−0.13	+0.05	−0.17	+1.02	−2	−2
			−0.01	+0.05	−0.13	+0.97	+2	−2

Notes: All the data are shown as the least squares mean (standard error).

Abbreviations: TC, total cholesterol; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; TG, triglycerides; SBP, systolic blood pressure; DBP, diastolic blood pressure; QW, once weekly; BID, twice daily; QD, once daily; IU, International Units; N/A, not available.

DruckerDJBuseJBTaylorKExenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority studyLancet20083721240125018782641

 PubMed Web of Science ®Google Scholar

BuseJBDruckerDJTaylorKLDURATION-1: exenatide once weekly produces sustained glycemic control and weight loss over 52 weeksDiabetes Care20103361255126120215461

 PubMed Web of Science ®Google Scholar

DiamantMVan GaalLStranksSOnce weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes (DURATION-3): an open-label randomised trialLancet201037597332234224320609969

 PubMed Web of Science ®Google Scholar

BergenstalRMWyshamCMacConellLEfficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2): a randomised trialLancet2010376973943143920580422

 PubMed Web of Science ®Google Scholar

BlevinsTPullmanJMalloyJDURATION-5: exenatide once weekly resulted in greater improvements in glycemic control compared with exenatide twice daily in patients with type 2 diabetesJ Clin Endocrinol Metab20119651301131021307137

 PubMed Web of Science ®Google Scholar

InagakiNAtsumiYOuraTSaitoHImaokaTEfficacy and safety profile of exenatide once weekly compared with insulin once daily in Japanese patients with type 2 diabetes treated with oral antidiabetes drug(s): results from a 26-week, randomized, open-label, parallel-group, multicenter, noninferiority studyClin Ther20123491892190822884767

 PubMed Web of Science ®Google Scholar

DiamantMVan GaalLStranksSSafety and efficacy of once-weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes over 84 weeksDiabetes Care201235468368922357185

 PubMed Web of Science ®Google Scholar

Russell-JonesDCuddihyRMHanefeldMEfficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-naive patients with type 2 diabetes (DURATION-4): a 26-week double-blind studyDiabetes Care201235225225822210563

 PubMed Web of Science ®Google Scholar

JiLOnishiYAhnCWEfficacy and safety of exenatide once-weekly versus exenatide twice-daily in Asian patients with type 2 diabetes mellitusJ Diabetes Investig2013415361

 PubMed Web of Science ®Google Scholar

BuseJBNauckMForstTExenatide once weekly versus liraglutide once daily in patients with type 2 diabetes (DURATION-6): a randomised, open-label studyLancet2013381986111712423141817

 PubMed Web of Science ®Google Scholar

DiamantMVan GaalLGuerciBExenatide once weekly versus insulin glargine for type 2 diabetes (DURATION-3): 3-year results of an open-label randomised trialLancet Diabetes Endocrinol20142646447324731672

 PubMed Web of Science ®Google Scholar