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 Past studies of the drugs known as glucagon-like peptide-1 receptor
agonists - or GLP-1RAs - have found that the medications improve
blood sugar control and reduce body weight, but the review's lead
author said no research had compared the various versions
head-to-head.
"The main message is that today several drugs are available for the
control of hyperglycemia in type 2 diabetes, as never before," said
Dr. Francesco Zaccardi, of the Diabetes Research Center at Leicester
General Hospital in the U.K., "Therefore, it is even more important
to know differences and similarities among drugs."
In type 2 diabetes, the body can’t properly use or make enough of
the hormone insulin to convert blood sugar into energy.
The drugs compared in the study - three of which are on the market,
and two in development - stimulate insulin and have other beneficial
effects like slowing digestion, the study team writes in Annals of
Internal Medicine. All are taken once a week.
The American Diabetes Association and the European Association for
the Study of Diabetes currently recommend GLP-1RAs as an option for
people with type 2 diabetes who have tried other treatments like
lifestyle changes and metformin, which is a longstanding oral drug
used to improve blood sugar control.
For the new study, Zaccardi and colleagues analyzed data from 34
trials that included a total of 21,126 participants taking one of
the five GLP-1RAs.
They found that the drugs performed similarly in reducing blood
sugar, as well as heart disease risk factors like high blood
pressure, cholesterol and inflammation. The risk of dangerous blood
sugar lows known as hypoglycemia was also similar among people
taking all five drugs.
The medications differed, however, when it came to reducing weight
and HbA1c, which is a measure of average blood sugar levels over
about three months.
Dulaglutide 1.5 milligrams (mg), which is sold as Trulicity by Eli
Lilly; once-weekly exenatide, which is sold as Byetta by AstraZeneca;
and taspoglutide 20 mg, which is in development by Ipsen and Roche,
all performed better on those two points than albiglutide, which is
sold as Tanzeum by GlaxoSmithKline and semaglutide, in development
by Novo Nordisk.
Still, the differences were small. HbA1c is measured in percentages
with normal being below 6 percent and 6.5 percent or above being
considered diabetes. Zaccardi told Reuters Health in an email that
the greatest differences between the drugs were around 0.4 percent
for HbA1c and about three pounds of body weight.
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"The weight loss is instructive because a lot of people hear stories
of people losing a lot of weight, but the mean weight loss is
modest," said Dr. Sethu Reddy, chief of the Adult Diabetes Section
at the Joslin Diabetes Center in Boston.
The researchers also found that taspoglutide 20 mg has the highest
risk of nausea. And once-weekly exenatide increased heart rate
compared with albiglutide and dulaglutide by 1.4 to 3.2 beats per
minute.
Zaccardi said that few comparisons like this study have been done
between similar diabetes drugs, which limits their ability to
compare the results to other types of treatments.
"I believe that the study underlines the necessity to perform direct
comparisons among drugs of the same class to better clarify the pros
and cons of each drug," he added.
Reddy, who was not involved in the new review, also cautioned that
the findings are based on a comparison of existing data from
separate studies.
"It’s not the 'real deal' so to speak in that there are no trials
comparing these drugs to one another," he said.
But, Reddy added, the review and new research into GLP-1RAs should
give people comfort since it shows the drugs really do work to
reduce high blood sugar and other diabetes symptoms.
"That makes me more comfortable that this therapeutic area is real,
and not a flash in the pan and the mechanism is real," he said.
SOURCE: http://bit.ly/SQRXAa Annals of Internal Medicine, online
December 7, 2015.
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