Perspectives on Diabetes Care

New GLP-1 Agonist

May 21, 2014, 01:00 AM

One year ago, I wrote a blog about INVOKANA – or canagliflozin – as the first agent within a new class for diabetes. In my blog, I mentioned that investigational and emerging agents attempt to meet certain characteristics to have a “place at the table” in the management of type 2 diabetes mellitus. Some of the desired characteristics include minimal to no risk of hypoglycemia and weight neutral or loss with an effective A1c reduction. These characteristics can be found within the class of glucagon-like peptide-1 (GLP-1) agonists. Currently, there are three available GLP-1 agonists – twice-daily exenatide immediate-release (BYETTA), once-daily liraglutide (VICTOZA), and once-weekly exenatide extended-release (BYDUREON).

On April 15, a new GLP-1 agonist was approved for the management of type 2 diabetes mellitus. Albiglutide or TANZEUM is the second FDA-approved once-weekly agent in this particular class of medications. A GLP-1 agonist has multiple mechanisms of action that can be benefit for a patient with type 2 diabetes. As a review, a GLP-1 agonist increases insulin secretion from beta-cells and suppresses glucagon secretion from alpha-cells. In addition, a GLP-1 agonist can slow gastric emptying and promote satiety.

Albiglutide is similar to exenatide extended-release. While the full package insert is not available, here are the key points regarding albiglutide:

• Indication includes use as monotherapy or combination therapy with metformin, glimepiride, pioglitazone or insulin
• Half-life is 5 days, allowing for once-weekly administration
• Warning includes thyroid C-cell tumors among individuals with a personal or family history
• Safety profile includes diarrhea, nausea, and injection site reactions
• Availability in an injector pen, to be administered in abdomen, thigh or arm
• Dose is 30 mg subcutaneously once-weekly, with maximum dose of 50 mg per week.

Compared to other GLP-1 agonists, albiglutide offers several advantages, such as weight loss, minimal risk of hypoglycemia (unless used with insulin or sulfonylurea), and effective A1c reduction as mono- or combination therapy. To me, I am very interested in learning about the injector pen. In addition, I think albiglutide is a good option, but cost will be a big factor. I expect albiglutide to have a similar cost to other GLP-1 agonists (estimated $300 per month). With this new approved agent, I would reinforce that diabetes management is individualized considering efficacy, tolerability, patient preference and cost for our patients.