American Association of Clinical Endocrinology Annual Meeting

American Association of Clinical Endocrinology Annual Meeting

Issue: May 2011
May 01, 2011
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Meta-analysis: Superior glucose control achieved with liraglutide vs. other therapies

Issue: May 2011
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American Association of Clinical Endocrinologists 20th Annual Meeting

SAN DIEGO — Regardless of baseline HbA1c level, patients with type 2 diabetes were more likely to achieve blood glucose control with once-daily liraglutide than with other commonly used antidiabetes medications, according to results of a new meta-analysis.

Researchers analyzed seven studies that examined liraglutide (Victoza, Novo Nordisk), including the six phase 3 Liraglutide Effect and Action in Diabetes (LEAD) studies, to determine mean changes in HbA1c over 26 weeks. Liraglutide 1.8 mg was compared with exenatide (Byetta, Amylin), insulin glargine (Lantus, Sanofi-Aventis), glimepiride, rosiglitazone (Avandia, GlaxoSmithKline) and sitagliptin (Januvia, Merck). Baseline HbA1c categories included ≤7.5%; >7.5% to 8%; >8% to 8.5%; >8.5% to 9%; and >9%.

Results showed that all diabetes therapies improved blood glucose control across all baseline HbA1c categories, with greater reductions at higher baseline HbA1c levels as compared with placebo, which was added to background therapy. The greatest reductions were observed in patients taking liraglutide, and ranged from 0.7% in the ≤7.5% category to 1.8% in the >9% category. Liraglutide reductions were followed by insulin glargine (0.3% to 1.5%) and exenatide (0.4% to 1.3%). Sitagliptin was associated with no reduction in the ≤7.5% category to 1.1% in the >9% category. Patients taking sulfonylureas experienced reductions ranging from 0.4% to 1.4%. Finally, patients taking thiazolidinediones such as rosiglitazone had the narrowest margin of reduction, ranging from 0.4% in the ≤7.5% category to 0.8% in the >9% category, according to data from a press release.

The researchers also used logistic regression to compare the percentage of patients achieving the American Association of Clinical Endocrinologists’ target HbA1c level of ≤6.5%. They found that significantly more patients (63%) in the baseline ≤7.5% HbA1c category who were treated with liraglutide achieved the AACE-recommended target as compared with the other antidiabetic therapies analyzed (20% to 49%).

“What is so encouraging about these data is that Victoza, at all baseline HbA1c levels, helped type 2 diabetes patients achieve improved blood sugar control,” Robert Henry, MD, president of Medicine & Science, American Diabetes Association, and professor of medicine in the department of medicine, University of California, San Diego, said in a press release. “This is particularly promising since we know many type 2 diabetes patients continue to struggle with blood sugar control.”

Liraglutide was approved by the FDA in January 2010 as an adjunct to diet and exercise to improve blood glucose control in adults with type 2 diabetes.

Disclosure: The meta-analysis was conducted by Novo Nordisk.

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PERSPECTIVE

The study presented was a meta-analysis of all of the LEAD studies. Essentially, in the LEAD studies, a series of head-to-head studies were done comparing liraglutide to all of the other existing antidiabetic therapies, either alone or on a baseline platform of prior metformin, sulfonylurea or TZD therapy. What can be said is that in every case liraglutide was superior in terms of glucose control, and surprisingly did equal to or superior in comparison to insulin. The reasons for this are multiple, including the fact that patients don't get hypoglycemic on liraglutide and, therefore, you can get more intensive glycemic control easily compared to insulin or sulfonylurea. It may be a better treatment option in patients at risk for additional hypoglycemia or weight gain.

– Alan J. Garber, MD, PhD
Endocrine Today Chief Medical Editor

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