Public Release: 

No clear choice among newly available once-weekly diabetes medications

American College of Physicians

1. No clear choice among newly available once-weekly diabetes medications

Once-weekly GLP-1RAs vary in safety and efficacy; direct comparisons needed to clarify benefits and harms

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1432

URL live when embargo lifts

A systematic evidence review and meta-analysis fails to clarify which once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RAs) treatments have the most favorable safety and efficacy profile for treating type 2 diabetes. The newly-available medications vary in terms of cardiometabolic efficacy and adverse effects and direct comparisons are needed to better inform physician prescribing. The research is published in Annals of Internal Medicine.

In the past decade, the number of approved diabetes treatments has increased significantly. New once-weekly GLP-1RAs stimulate insulin and inhibit glucagon secretion, slow gastric emptying, and reduce food intake. This new class of drug has been recommended for patients who are not achieving metabolic targets taking metformin alone or with another glucose-lowering agent.

Since no direct comparisons between once-weekly therapies have been available, researchers reviewed published research to estimate the comparative efficacy and safety of the once-weekly GLP-1RAs albiglutide, dulaglutide, exenatide, semaglutide, and taspoglutide. They found that the drugs shared similar outcomes for blood pressure, blood lipids, and C-reactive protein. However, a modest increase in heart rate was seen with once-weekly exenatide versus albiglutide. The medications also had some differences. Dulaglutide 1.5 mg, once-weekly exenatide, and taspoglutide, 20 mg were associated with greater reductions in HbA1c, fasting plasma glucose, and body weight compared with albiglutide and other once-weekly GLP-1RAs at lower doses. All of the medications significantly increased the risk for nausea, with taspoglutide, 20 mg and 10mg and dulaglutide showing the greatest risk. The risk for hypoglycemia did not differ among once-weekly GLP-1RAs.

The authors of an accompanying editorial express frustration over the lack of head-to-head comparisons and suggest more research to help patients and physicians find the most tolerable and least-expensive treatment.

Note: For an embargoed PDF or author contact information, please contact Cara Graeff.

2. Researchers suggest that dermatology consultation may help patients taking anti-TNF therapy for IBD stay on their meds

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0729

URL live when embargo lifts

Skin lesions occur frequently in patients taking anti-tumor necrosis factor (TNF) antagonists for inflammatory bowel disease (IBD), but discontinuation of therapy is usually not required. Patients should be informed about the risks for skin lesions and their physicians should refer them early to a dermatologist. The study is published in Annals of Internal Medicine.

Anti-TNF antagonists help to reduce symptoms, heal mucosal ulcers, reduce hospitalizations and surgeries, and spare corticosteroid use in patients with IBD. Because their use is associated with psoriasis-like skin manifestations, it is important to advise patients on preventive measures or alternative therapeutic options, especially for those at increased risk.

Researchers studied health records for 917 consecutive patients with IBD who initiated anti-TNF therapy to accurately describe patients that did and did not develop skin lesions. They found that skin lesions occurred frequently in association with anti-TNF therapy and typically developed at flexural regions, genitalia, and the scalp. The researchers recommend close surveillance and early referral to a dedicated dermatologist to prevent patients from discontinuing treatment.

Note: For an embargoed PDF or author contact information, please contact Cara Graeff.

Also in this issue:

Diagnosis of Latent Tuberculosis Infection: Too Soon to Pull the Plug on the Tuberculin Skin Test

Lauren F. Collins, MD; Carolina Geadas, MD; Jerrold J. Ellner, MD

Ideas and Opinions http://www.annals.org/article.aspx?doi=10.7326/M15-1522

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