Look for New GLP-1 Agonists for Type 2 Diabetes

You'll see Adlyxine (ad-LIKS-een, lixisenatide) and Ozempic (oh-ZEM-pik, semaglutide) join the crowded field of GLP-1 agonists.

Adlyxine is available now...and Ozempic will be in March. This will bring the tally in Canada to six GLP-1 agonist products for diabetes.

Be familiar with how the different agents compare.

A1C lowering. Expect Ozempic, Bydureon (exenatide ER), Trulicity (dulaglutide), or Victoza (liraglutide) to lower A1C by about 1.5% when added to metformin...versus about 1% with Adlyxine or Byetta (exenatide).

Weight loss. Explain that Ozempic reduces weight by about 4 kg...compared to 2 to 3 kg with the others.

CV risk reduction. Point out that Ozempic may reduce CV risk in type 2 patients already at high CV risk...but so far Victoza is the only GLP-1 agonist shown to reduce both CV risk and CV death.

Dosing frequency. Bydureon, Ozempic, and Trulicity are injected subcutaneously once WEEKLY...compared to once DAILY for Adlyxine or Victoza...or TWICE daily for Byetta.

Side effects. We know all GLP-1 agonists can cause nausea. But explain it often improves over time.

Ozempic is the only GLP-1 agonist with a warning about retinopathy complications. Patients with existing retinopathy are at higher risk.

Cost. Expect Adlyxine to cost about $120 per month...versus $150 for Byetta...or at least $200 for the others.

Continue to recommend metformin first for type 2 diabetes.

If an add-on is needed for CV patients, lean toward Victoza or the "flozin" Jardiance (empagliflozin)...they reduce CV risk and CV death.

For other patients, see our Stepwise Treatment of Type 2 Diabetes algorithm to compare metformin add-ons based on hypoglycemia risk, etc.

Also get our charts, Diabetes Meds and CV Impact for more on CV outcomes...and Comparison of GLP-1 Agonists for tips on titration.

Key References

  • N Engl J Med 2015;373(23):2247-57
  • N Engl J Med 2016;375(19):1834-44
Pharmacist's Letter Canada. Feb 2018, No. 340226

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