GLP-1 receptor agonists or DPP-4 inhibitors: How to guide the clinician?

Abstract

RESUME :Le traitement pharmacologique du diabète de type 2 s'est enrichi, ces dernières années, de l'apport des médicaments à effet incrétine ciblant le glucagon-like peptide-1 (GLP-1). Ces médicaments comprennent soit des agonistes des récepteurs au GLP-1, à courte (injection 1 ou 2 x par jour : exénatide, liraglutide, lixisénatide) ou longue durée d'action (injection hebdomadaire : exénatide à libération prolongée, albiglutide, dulaglutide, taspoglutide) ; soit des agents inhibant l'enzyme inactivant le GLP-1, la dipeptidyl peptidase-4 (DPP-4), actifs par voie orale, les gliptines (sitagliptine, vildagliptine, saxagliptine, linagliptine, nombreuses, à quasi tous les stades du diabète de type 2. Le choix pourra s'orienter selon les caractéristiques cliniques, les objectifs fixés ou simplement les préférences du patient. Mots-clés :

Efficacy and Acceptability of Glycemic Control of Glucagon-Like Peptide-1 Receptor Agonists among Type 2 Diabetes: A Systematic Review and Network Meta-Analysis

“…The beneficial glycemic level lowering effect of all GLP-1 RAs in our analysis was consistent with previous studies [ 10 , 121 ]. Scheen’s [ 122 ] study reported that the HbA1c lowering potential for GLP-1 RAs is approximately at 1%–1.5% on average. A review of 8 head-to-head phase III clinical programs showed that the primary efficacy endpoint in all of the GLP-1 RAs was change in HbA1c from baseline with a noninferiority margin of 0.4%[ 111 ].…”

Patient preference and tolerability of a DPP-4 inhibitor versus a GLP-1 analog in patients with type 2 diabetes mellitus inadequately controlled with metformin: a 24-week, randomized, multicenter, crossover study

“…Although both GLP-1 analogs and DPP-4 inhibitors have similar pharmacological approaches, their routes of administration (subcutaneous versus oral) differ considerably [Scheen, 2013]. Furthermore, physicians may guide the pharmacological choice of treatment based on the clinical characteristics of patients with diabetes, drug safety profile, therapeutic goals, and patient preference [Inzucchi, 2002].…”

“…Incretin-based therapies such as dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide-1 (GLP-1) analogs increase plasma concentrations of active GLP-1 and exert antihyperglycemic effects in a glucose-dependent manner [Scheen, 2013]. Although these therapies are safe and effective in lowering hemoglobin A1c (HbA 1c ) without the risk of hypoglycemia and weight gain, they vary in administration route, efficacy, and side effects.…”

Dulaglutide-induced cerebral venous thrombosis in a patient with type 2 diabetes mellitus

“…GLP-1 effects include increased insulin secretion, decreased glucagon release, increased satiety and slowed gastric emptying 4. The most common adverse reactions to dulaglutide reported in 5% or more of patients include nausea, diarrhoea, vomiting, abdominal pain, decreased appetite, dyspepsia and fatigue 5 6.…”