Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-34

Albiglutide (Eperzan™) Long-acting GLP-1 Analogue with 97% homology (resemblance) to human GLP-1. • TDD: 30 mg – 50 mg • Frequency: Once weekly • Taken same day of the week (with or without meal) or at least days before next scheduled dose.

Use limited as requires reconstitution. More steps needed to do injection.

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Caution: •

If eGFR < 15 mL/min/1.73m 2 Each prefilled pen will deliver: • 30 mg/0.5 mL (4 pens) • 50 mg/0.5 mL

Needle included.

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• Missed dose: taken if >72 hours until next scheduled dose.

Dosing schedule • Initiate at 30 mg. • Titrate to 50 mg for added BG control.

Comparison of GLP-1 Receptor Agonists There have been a number of clinical trials comparing the effectiveness of the various GLP-1 RA agents. In the LEAD 6 trial, once-daily liraglutide 1.8 mg had a statistically significant reduction in A1C 0.33% (p<0.0001) and FBG 1.01 mmol/L (p<0.0001) compared to exenatide 10 ug twice-daily in adults with type 2 diabetes. Both drugs resulted in similar weight loss (3.0 kg); however, the duration of nausea was significantly less in the liraglutide group (0.448, p 0.0001) (72). A further reduction in A1C (-0.32 +/- 0.043%, p<0.0001) and weight (-0.9 +/- 0.15kg, p<0.0001) occurred when participants were switched from exenatide twice-daily to liraglutide once-daily (73). Multiple phase 3 studies have demonstrated liraglutide’s superiority to other GLP1-RA in terms of glucose lowering and/or weight. Once-daily liraglutide had greater A1C reductions compared to once-daily lixisenatide (-0.62%; p<0.001), once-weekly, exenatide (-0.21%; failed to meet noninferiority), versus once-weekly albiglutide (-0.21%; noninferiority p=0.0846). Dulaglutide once-weekly had similar A1C reductions to once-daily liraglutide (AWARD-6 trial; 1.42% vs 1.36%; noninferiority p<0.0001) (49). In terms of weight, once-weekly sc semaglutide had greater weight reductions followed by once-daily liraglutide compared to dulaglutide once-weekly (-0.7 kg; p=0.01), once-weekly exenatide (-0.9kg; p<0.05) and least weight loss with once-daily lixisenatide (-0.6kg; p<0.23) (49). Studies have shown the overall rate of nausea is less with once weekly GLP-1 RA versus GLP1-RA agents taken once-daily or twice-daily (74). Short-acting GLP1RAs have a greater effect on postprandial plasma levels of glucose for meals directly following their daily or twice-daily administration, whereas