Glycemic Control and Weight Outcomes for Exenatide Once Weekly Versus Liraglutide in Patients with Type 2 Diabetes: A 1-Year Retrospective Cohort Analysis

McAdam‐Marx, Carrie; Nguyen, Hannah; Schauerhamer, Marisa B.; Singhal, Manmohan; Unni, Sudhir; Ye, Xiangyang; Cobden, D

doi:10.1016/j.clinthera.2016.11.003

Cited by 19 publications

(24 citation statements)

References 11 publications

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“…This hypothesis is supported by reported exenatide once weekly HbA1c change in real‐world studies conducted by McAdam‐Marx et al (−0.5 [1.5]%) and Saunders et al (−0.64 [1.32]%) which used the same data source. However, this hypothesis does not explain why weight loss in the present study for exenatide once weekly was lower than in RCTs or in Saunders et al (−2.1 [13.9] kg) and McAdam‐Marx et al (−2.2 [0.4] kg). McAdam‐Marx et al assessed outcomes at 1 year vs 6 months, possibly allowing more time for maximum weight loss to have been achieved.…”

Section: Discussioncontrasting

confidence: 87%

“…These differences may reflect real‐world factors, such as lower follow‐up intensity and lower medication adherence. This hypothesis is supported by reported exenatide once weekly HbA1c change in real‐world studies conducted by McAdam‐Marx et al (−0.5 [1.5]%) and Saunders et al (−0.64 [1.32]%) which used the same data source. However, this hypothesis does not explain why weight loss in the present study for exenatide once weekly was lower than in RCTs or in Saunders et al (−2.1 [13.9] kg) and McAdam‐Marx et al (−2.2 [0.4] kg).…”

Section: Discussionsupporting

confidence: 57%

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Comparative effectiveness of once‐weekly glucagon‐like peptide‐1 receptor agonists with regard to 6‐month glycaemic control and weight outcomes in patients with type 2 diabetes

Unni

Wittbrodt

José

et al. 2017

Diabetes Obesity Metabolism

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A retrospective cohort study was conducted in patients with type 2 diabetes in an electronic medical record database to compare real-world, 6-month glycated haemoglobin (HbA1c) and weight outcomes for exenatide once weekly with those for dulaglutide and albiglutide. The study included 2465 patients: exenatide once weekly, n = 2133; dulaglutide, n = 201; and albiglutide, n = 131. The overall mean (standard deviation [s.d.]) age was 60 (11) years and 54% were men; neither differed among the comparison groups. The mean (s.d.) baseline HbA1c was similar in the exenatide once-weekly (8.3 [1.7]%) and dulaglutide groups (8.5 [1.5]%; P = .165), but higher in the albiglutide group (8.7 [1.7]%; P < .001). The overall mean (s.d.) HbA1c change was -0.5 (1.5)% (P < .001) and this did not differ among the comparison groups in either adjusted or unadjusted analyses. The mean (s.d.) weight change was -1.4 (4.7) kg for exenatide once weekly and -1.6 (3.7) kg for albiglutide (P = .579), but was greater for dulaglutide, at -2.7 (5.7) kg (P = .001). Outcomes were similar in subsets of insulin-naive patients with baseline HbA1c ≥7.0% or ≥9.0%. All agents significantly reduced HbA1c at 6 months, with no significant differences among agents or according to baseline HbA1c in insulin-naive subgroups.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionsupporting

confidence: 57%

Comparative effectiveness of once‐weekly glucagon‐like peptide‐1 receptor agonists with regard to 6‐month glycaemic control and weight outcomes in patients with type 2 diabetes

Unni

Wittbrodt

José

et al. 2017

Diabetes Obesity Metabolism

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“…After excluding those not reporting poolable data for any of the three elected outcome measures and adding the results of the present study, we included in the meta‐analysis 3 studies reporting the change in HbA1c (6035 patients) and the change in body weight (9384 patients), and 8 studies reporting discontinuation rates (110 232 patients). Follow‐up duration was 6 months in 5 studies and 12 months in the others . Altogether, there was no difference between liraglutide and ExeOW for the change in HbA1c [0.01%; 95% confidence interval (CI) ‐0.08; 0.09; no heterogeneity, Figure B] or for the change in body weight (0.12 kg; 95% CI ‐0.26; 0.51; no heterogeneity, Figure C).…”

Section: Resultsmentioning

confidence: 99%

“…Panels B‐D show the forest plots for the 3 outcomes considered: B, change in HbA1c, C, change in body weight and D, discontinuation rates. In the paper by McAdam‐Marx et al, unadjusted data were recorded for the change in HbA1c and body weight, and, for the change in HbA1c, only the insulin‐free subgroup was considered. In the paper by Otto et al, cohort 1 was considered, which was composed by GLP‐1RA initiators, while cohort 2 was composed by intra‐class switchers.…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of exenatide once‐weekly versus liraglutide in routine clinical practice: A retrospective multicentre study and meta‐analysis of observational studies

Fadini

Bonora

Lapolla

et al. 2019

Diabetes Obesity Metabolism

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In this study, we retrospectively compared the effectiveness of exenatide once‐weekly (ExeOW) versus liraglutide in non‐insulin treated patients with type 2 diabetes followed under routine care. We also present a meta‐analysis of similar observational studies available in the literature. In our multicentre retrospective study, patients initiating ExeOW ( n = 204) or liraglutide ( n = 410) had similar baseline clinical characteristics. Change in HbA1c at 6 months was superimposable in the two groups (−0.7% ± 1.0%), and changes in body weight were also similar (ExeOW ‐2.2 ± 3.7 kg; liraglutide −2.5 ± 4.3 kg; p = 0.457). Discontinuation rates were numerically but not significantly lower for ExeOW versus liraglutide. Pooling these data with those of observational studies available in the literature yielded superimposable effects between the two groups for the change in HbA1c and body weight, with a higher risk of discontinuation (mainly based on pharmacy refill rates) for ExeOW. We conclude that, in patients under routine care, initiation of ExeOW provides similar benefits on HbA1c and body weight as initiation of liraglutide. These data help view the results of randomized controlled trials from the perspective of their application in routine clinical practice.

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“…Approved for treating diabetes, exenatide also induces weight loss in overweight diabetics 46. This drug has been used off-label for weight loss, but apparently infrequently.…”

Section: Introduction To Epidemiology Of Obesity and Developments In mentioning

confidence: 99%

Off-label drugs for weight management

Hendricks

2017

DMSO

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The global pandemic of obesity and overweight now affects between 2.8 and 3.5 billion of the world population and shows no signs of abatement. Treatment for what is now recognized as a chronic disease includes pharmacotherapy, considered an essential component of comprehensive therapy. New drug discovery is robust, but the pace of the US Food and Drug Administration approval for obesity drugs has been glacial, and only a handful of approved drugs are available for treating obesity. In the last 20 years, the US Food and Drug Administration has approved 208 drugs for cancer, 118 for cardiovascular diseases, 168 for neurological diseases, and 223 endocrinologic drugs, but only 6 for obesity, 2 of which have been taken off market. Currently, there are only 9 drugs approved by the FDA for obesity treatment. US physicians have turned to off-label drug use in their effort to care for increasing numbers of patients with excess adiposity. Phentermine is the most commonly used drug for treating obesity. Although approved only for short-term use, US physicians have used it successfully for long-term since its initial approval in 1959. This drug, used off-label for long-term, has proven to be safe and effective, far safer than the disease it is used to treat. Phentermine and diethylpropion, an equally safe but somewhat less effective drug, are both generic and therefore inexpensive. These drugs have been maligned inappropriately because their two-dimensional structure diagrams resemble amphetamine and also because of unproven presumptions about their potential adverse effects. In the face of an increasing epidemic, worldwide obese and overweight patients deserve effective treatment that prescribing these drugs could provide, if rehabilitated and used more frequently. US physicians will likely continue to use any drug proven useful off-label for this illness until such time as more effective drugs are approved.

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Glycemic Control and Weight Outcomes for Exenatide Once Weekly Versus Liraglutide in Patients with Type 2 Diabetes: A 1-Year Retrospective Cohort Analysis

Cited by 19 publications

References 11 publications

Comparative effectiveness of once‐weekly glucagon‐like peptide‐1 receptor agonists with regard to 6‐month glycaemic control and weight outcomes in patients with type 2 diabetes

Comparative effectiveness of once‐weekly glucagon‐like peptide‐1 receptor agonists with regard to 6‐month glycaemic control and weight outcomes in patients with type 2 diabetes

Comparative effectiveness of exenatide once‐weekly versus liraglutide in routine clinical practice: A retrospective multicentre study and meta‐analysis of observational studies

Off-label drugs for weight management

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