Patel Dhiren
VA Boston Healthcare System, Boston, MA, USA.
J Clin Pharm Ther. 2020 Sep;45 Suppl 1(Suppl 1):28-42. doi: 10.1111/jcpt.13224.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may confer a range of benefits for people with type 2 diabetes (T2D), which is reflected through their position within diabetes treatment guidelines. The objective of this narrative review is to explore the efficacy data of once-weekly (QW) GLP-1 RAs in terms of glycaemic control, body weight reduction, cardiovascular (CV) outcomes and potential renal protective effects to assist pharmacists and other healthcare professionals (HCPs) in treatment discussions with patients.
This a narrative review focused on 31 clinical trials involving the Phase 3 clinical programmes of the QW GLP-1 RAs dulaglutide, exenatide extended-release (ER) and semaglutide subcutaneous (s.c.).
The clinical trials were divided by their comparator arms and examined for trends. All QW GLP-1 RAs were superior to placebo for reductions in glycated haemoglobin (HbA ) and body weight. Data regarding QW GLP-1 RAs versus metformin were limited, likely due to metformin's use as the first-line pharmacologic for T2D. In the robust head-to-head trials of QW versus QW GLP-1 RAs, semaglutide s.c. was superior to both dulaglutide and exenatide ER regarding HbA and body weight; however, QW versus once-daily GLP-1 RA trials had mixed results depending on the comparators. Finally, in QW GLP-1 RA versus insulin trials, all QW GLP-1 RAs were as effective as insulin, particularly when hypoglycaemia and body weight were also considered. CV outcome trials demonstrated benefits in major adverse CV events and renal outcomes for semaglutide and dulaglutide.
This review collates recently published data and previously published Phase 3 results to allow pharmacists and other HCPs to understand all of the efficacy data available and the corresponding impact on treatment guidelines. QW GLP-1 RAs are emerging as important therapeutic options for people with T2D as they offer a spectrum of benefits extending beyond glycaemic control, but it is important to be aware of their efficacy differences when prescribing and discussing them with patients.
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）可能为2型糖尿病（T2D）患者带来一系列益处，这一点在糖尿病治疗指南中有所体现。本叙述性综述的目的是探讨每周一次（QW）GLP-1 RAs在血糖控制、体重减轻、心血管（CV）结局及潜在肾脏保护作用方面的疗效数据，以协助药剂师和其他医疗保健专业人员（HCPs）与患者进行治疗讨论。
本叙述性综述聚焦于31项临床试验，这些试验涉及QW GLP-1 RAs度拉糖肽、艾塞那肽缓释剂（ER）和司美格鲁肽皮下注射剂的3期临床项目。
临床试验按对照臂进行划分并分析趋势。所有QW GLP-1 RAs在降低糖化血红蛋白（HbA）和体重方面均优于安慰剂。关于QW GLP-1 RAs与二甲双胍对比的数据有限，可能是由于二甲双胍作为T2D的一线药物使用。在QW GLP-1 RAs之间强有力的头对头试验中，司美格鲁肽皮下注射剂在HbA和体重方面优于度拉糖肽和艾塞那肽ER；然而，QW GLP-1 RAs与每日一次GLP-1 RA试验的结果因对照药物而异。最后，在QW GLP-1 RAs与胰岛素试验中，所有QW GLP-1 RAs与胰岛素效果相当，尤其是在考虑低血糖和体重时。CV结局试验表明司美格鲁肽和度拉糖肽在主要不良CV事件和肾脏结局方面有益。
本综述整理了最近发表的数据和先前发表的3期结果，以使药剂师和其他HCPs了解所有可用的疗效数据及其对治疗指南的相应影响。QW GLP-1 RAs正成为T2D患者重要的治疗选择，因为它们提供了一系列超出血糖控制的益处，但在开药和与患者讨论时，了解它们的疗效差异很重要。
