The efficacy and safety of exenatide once weekly in patients with type 2 diabetes

ABSTRACT

Introduction: Exenatide once weekly (QW) is a glucagon-like peptide 1 receptor agonist (GLP-1RA) that was approved in 2012 in Europe and the U.S.A. for the treatment of type 2 diabetes (T2D).

Areas covered: This review provides an overview of the safety and efficacy of exenatide QW for the treatment of T2D and evaluates the benefit–risk ratio compared to other available long-acting GLP-1RAs. In addition, the authors provide an outline of the novel formulations and delivery methods of exenatide.

Expert opinion: Exenatide QW is an efficacious and safe treatment for T2D. However, head-to-head trials have demonstrated exenatide QW to be inferior to liraglutide and semaglutide with respect to effects on fasting plasma glucose, glycated hemoglobin A1c, and bodyweight. In addition, exenatide QW appears inferior to liraglutide and semaglutide in terms of cardiovascular risk reduction. Currently, the overall risk-benefit profiles for the range of GLP-1RAs point to liraglutide and semaglutide as first-choice for the management of T2D, which has been confirmed by a recently published consensus report on the treatment of T2D from the American Diabetes Association and the European Association for the Study of Diabetes. The pricing of exenatide QW will most likely be a key determinant for its place in the future management of T2D.

KEYWORDS:

• Exenatide extended-release
• exenatide QW
• glucagon-like peptide 1
• glucagon-like peptide 1 receptor agonist
• glycaemic control
• type 2 diabetes
• cardiovascular adverse events

Box 1. Drug Summary Box

Table

Declaration of interest

A Brønden has received a lecture fee from AstraZeneca. TF Dejgaard has consulted for Novo Nordisk and received funding from Novo Nordisk and AstraZeneca. T Vilsbøll has received fees for consultancy or for being part of an advisory board for Amgen Inc, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, and Sanofi. She has furthermore received fees for lectures from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Merck Sharp & Dohme, Novartis, and Novo Nordisk, and has received research support from Merck Sharp & Dohme and Novo Nordisk. FK Knop has received fees for consultancy or being part of an advisory board for AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Gilead Sciences, Novo Nordisk, Ono Pharmaceuticals, Sanofi, and Zealand Pharma and has received fees for lectures from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Gilead Sciences, Merck Sharp & Dohme, Novo Nordisk, Ono Pharmaceuticals, Sanofi, and Zealand Pharma. Furthermore, he has received research support from AstraZeneca and Sanofi. TF Dejgaard and T Vilsbøll have contributed to a pivotal trial for semaglutide [53] while FK Knop and T Vilsbøll have contributed to pivotal trials for liraglutide [2,82]. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.