An overview of once-weekly glucagon-like peptide-1 receptor agonists--available efficacy and safety data and perspectives for the future

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Incretin-based therapies, such as the injectable glucagon-like peptide-1 (GLP-1) receptor agonists and orally administered dipeptidyl peptidase-4
(DPP-4) inhibitors, have recently been introduced into clinical practice. At present, the GLP-1 receptor agonists need to be administered once
or twice daily. Several once-weekly GLP-1 receptor agonists are in phase 3 development. This review examines the efficacy, safety and
perspective for the future of the once-weekly GLP-1 receptor agonists: exenatide once weekly, taspoglutide, albiglutide, LY2189265 and
CJC-1134-PC, and compared them to the currently available agonists, exenatide BID and liraglutide QD. A greater reduction in haemoglobin A1c
(HbA1c) and fasting plasma glucose was found with the once-weekly GLP-1 receptor agonists compared with exenatide BID, while the effect
on postprandial hyperglycaemia was modest with the once-weekly GLP-1 receptor agonist. The reduction in HbA1c was in most studies greater
compared to oral antidiabetic drugs and insulin glargine. The reduction in weight did not differ between the short- and long-acting agonists. The
gastrointestinal side effects were less with the once-weekly agonists compared with exenatide BID, except for taspoglutide. Antibodies seem
to be most frequent with exenatide once weekly, while hypersensitivity has been described in few patients treated with taspoglutide. Injection
site reactions differ among the long-acting GLP-1 receptor agonists and are observed more frequently than with exenatide BID and liraglutide.
In humans, no signal has been found indicating an association between the once-weekly agonists and C-cell cancer. The cardiovascular safety,
durability of glucose control and effect on weight will emerge from several ongoing major long-term trials. The once-weekly GLP-1 receptor
analogues are promising candidates for the treatment of type 2 diabetes, although their efficacy may not be superior to once-daily analogue
Original languageEnglish
JournalDiabetes, Obesity and Metabolism
Issue number5
Pages (from-to)394-407
Number of pages14
Publication statusPublished - May 2011

    Research areas

  • Biological Markers, Diabetes Mellitus, Type 2, Dipeptidyl-Peptidase IV Inhibitors, Female, Glucagon-Like Peptide 1, Hemoglobin A, Glycosylated, Humans, Hyperglycemia, Hypoglycemic Agents, Immunoglobulin Fc Fragments, Male, Peptides, Receptors, Glucagon, Recombinant Fusion Proteins, Venoms

ID: 33727102