Once-weekly exenatide reduces HbA_1c more than the twice-daily formulation

Drucker DJ et al. (2008) Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet 372: 1240–1250

The glucagon-like peptide 1 receptor agonist exenatide improves glycemic control and reduces body weight in patients with type 2 diabetes mellitus. Exenatide is currently given twice daily by injection; however, this formulation does not provide continuous glucagon-like peptide 1 receptor activation. Drucker et al. report that a long-acting-release (LAR) formulation of exenatide, which can be given once weekly by injection, provides superior glycemic control compared with that of the twice-daily formulation.

The 30-week, randomized, noninferiority study included 295 patients with type 2 diabetes mellitus who were naive to drug treatment or were receiving ≥1 oral antidiabetic agent. Participants were randomly allocated to receive 2 mg LAR exenatide once weekly or 10 µg exenatide twice daily.

Compared with the twice-daily formulation, LAR exenatide produced greater declines in HBA_1c levels and significantly increased the proportion of patients who achieved a target HbA_1c level of ≤ 7.0% (77% versus 61%). Body weight declined to a similar extent in the two groups. The two regimens also showed comparable results in terms of safety and tolerability, although treatment-related nausea occurred in fewer patients treated once weekly.

Drucker and colleagues conclude that the once-weekly formulation of exenatide might be a convenient treatment option for patients with type 2 diabetes mellitus. Future studies are required to compare the efficacy of LAR exenatide with that of other classes of antidiabetic agents.