DURATION-5: Exenatide Once Weekly Resulted in Greater Improvements in Glycemic Control Compared with Exenatide Twice Daily in Patients with Type 2 Diabetes

被引:363
作者
Blevins, Thomas [1 ]
Pullman, John [2 ]
Malloy, Jaret [3 ]
Yan, Ping [4 ]
Taylor, Kristin [3 ]
Schulteis, Christine [3 ]
Trautmann, Michael [5 ]
Porter, Lisa [3 ]
机构
[1] Texas Diabet & Endocrinol, Austin, TX 78731 USA
[2] Mercury St Med, Dept Clin Res, Butte, MT 59701 USA
[3] Amylin Pharmaceut Inc, Med Dev, San Diego, CA 92121 USA
[4] Corp Analyt, San Diego, CA 92121 USA
[5] Eli Lilly & Co, Lilly Diabet, Indianapolis, IN 46285 USA
关键词
OPEN-LABEL; INSULIN GLARGINE; TREATED PATIENTS; BODY-WEIGHT; EXENDIN-4; METFORMIN; GLUCOSE; SAFETY; SULFONYLUREA; LIRAGLUTIDE;
D O I
10.1210/jc.2010-2081
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: We wanted to understand the effects of once-weekly vs. twice-daily glucagon-like peptide-1 receptor agonism for treatment of patients with type 2 diabetes. Objective: The objective of the study was to compare effects of exenatide once weekly (ExQW) and exenatide twice daily (ExBID) on glycemic control, body weight, and safety. Design: This was a 24-wk, randomized, open-label, comparator-controlled study. Setting: The study was conducted at 43 sites in the United States. Patients: The study population was 252 intent-to-treat patients with type 2 diabetes [baseline (mean +/- SD): glycosylated hemoglobin (HbA1c) 8.4 +/- 1.2%, fasting plasma glucose 171 +/- 47 mg/dl, weight 96 +/- 20 kg] that were drug naive (19%) or previously treated with one (47%) or multiple (35%) oral antidiabetic medications. Interventions: Interventions included ExQW 2 mg for 24 wk or ExBID 5 mu g for 4 wk followed by ExBID 10 mu g for 20 wk. Main Outcome Measure: The change in HbA1c from baseline to wk 24 was measured. Results: At 24 wk, ExQW produced significantly greater changes from baseline (least squares mean +/- SE) vs. ExBID in HbA1c (-1.6 +/- 0.1% vs. -0.9 +/- 0.1%; P < 0.0001) and fasting plasma glucose (-35 +/- 5 mg/dl vs. -12 +/- 5 mg/dl; P = 0.0008). Similar reductions in mean body weight from baseline to wk 24 were observed in both groups (-2.3 +/- 0.4 kg and -1.4 +/- 0.4 kg). Both treatments were generally well tolerated. Transient and predominantly mild to moderate nausea, the most frequent adverse event, was less common with ExQW (14%) than with ExBID (35%). Injection-site reactions were infrequent, but more common with ExQW. No major hypoglycemia occurred. Conclusions: Continuous glucagon-like peptide-1 receptor agonism with ExQW resulted in superior glycemic control, with less nausea, compared with ExBID in patients with type 2 diabetes. Both groups lost weight. (J Clin Endocrinol Metab 96: 1301-1310, 2011)
引用
收藏
页码:1301 / 1310
页数:10
相关论文
共 40 条
[11]  
DeFronzo RA, 2008, CURR MED RES OPIN, V24, P2943, DOI [10.1185/03007990802418851, 10.1185/03007990802418851 ]
[12]   Once weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes (DURATION-3): an open-label randomised trial [J].
Diamant, Michaela ;
Van Gaal, Luc ;
Stranks, Stephen ;
Northrup, Justin ;
Cao, Dachuang ;
Taylor, Kristin ;
Trautmann, Michael .
LANCET, 2010, 375 (9733) :2234-2243
[13]   Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study [J].
Drucker, Daniel J. ;
Buse, John B. ;
Taylor, Kristin ;
Kendall, David M. ;
Trautmann, Michael ;
Zhuang, Dangliang ;
Porter, Lisa .
LANCET, 2008, 372 (9645) :1240-1250
[14]   The insulinotropic effect of acute exendin-4 administered to humans: Comparison of nondiabetic state to type 2 diabetes [J].
Egan, JM ;
Clocquet, AR ;
Elahi, D .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2002, 87 (03) :1282-1290
[15]   Effectiveness of progressive dose-escalation of exenatide (exendin-4) in reducing dose-limiting side effects in subjects with type 2 diabetes [J].
Fineman, MS ;
Shen, LZ ;
Taylor, K ;
Kim, DD ;
Baron, AD .
DIABETES-METABOLISM RESEARCH AND REVIEWS, 2004, 20 (05) :411-417
[16]   Effect on glycemic control of exenatide (synthetic exendin-4) additive to existing metformin and/or sulfonylurea treatment in patients with type 2 diabetes [J].
Fineman, MS ;
Bicsak, TA ;
Shen, LZ ;
Taylor, K ;
Gaines, E ;
Varns, A ;
Kim, D ;
Baron, AD .
DIABETES CARE, 2003, 26 (08) :2370-2377
[17]  
Heine RJ, 2005, ANN INTERN MED, V143, P559, DOI 10.7326/0003-4819-143-8-200510180-00006
[18]   A SHARPER BONFERRONI PROCEDURE FOR MULTIPLE TESTS OF SIGNIFICANCE [J].
HOCHBERG, Y .
BIOMETRIKA, 1988, 75 (04) :800-802
[19]   The incretin system and its role in type 2 diabetes mellitus [J].
Holst, Jens Juul ;
Vilsboll, Tina ;
Deacon, Carolyn F. .
MOLECULAR AND CELLULAR ENDOCRINOLOGY, 2009, 297 (1-2) :127-136
[20]   Clinical Application of Incretin-Based Therapy: Therapeutic Potential, Patient Selection and Clinical Use [J].
Kendall, David M. ;
Cuddihy, Robert M. ;
Bergenstal, Richard M. .
AMERICAN JOURNAL OF MEDICINE, 2009, 122 (06) :37-50