Synopsis Exenatide injection (Bye...

Synopsis

Exenatide injection (Byetta) is an incretin mimetic. Incretins are endogenous proteins that modulate the glycemic reply Exenatide enhances glucose-dependent insulin secretion by dint of the pancreatic beta cells, suppresse inappropriately elevated glucagon secretion, and graduals gastric emptying. Its actions differ from those of insulin, sulfonylureas, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors, putting exenatide in its have class of medications. Exenatide is indicated simply in type 2 diabetes and is not a substitute for insulin. (1)

Safety

The largest clinical trial of exenatide therapy involved 733 patients who were given exenatide for 30 weeks in combination with metformin (Glucophage) and a sulfonylurea. principally adverse events were gastrointestinal; there were no reports of cardiovascular, pulmonary, hepatic, or renal adverse facts Exenatide did not increase the likelihood of hypoglycemia when added to metformin therapy. (2) however, when exenatide was added to sulfonylurea therapy there was an increase in the incidence of hypoglycemic adventures from 3.3 percent baseline to 144 percent in patients receiving exenatide 5 mcg twice daily and 357 percent in those receiving exenatide 10 mcg twice daily. (3) Exenatide has not been studied in combination with insulin, thiazolidinediones, or other hypoglycemic agents. It has not been studied with regard to its consequence on patient-oriented outcomes such as diabetes-related morbidity or mortality.

Tolerability

In controll trials, 7 percent of patients who took exenatide in addition to common therapy dropped out because of adverse results compared with 3 percent of patients in the placebo clusters Nausea and vomiting are the chiefly common side effects of exenatide therapy. Diarrhea, dizziness, headache, and feeling jittery also are customary Weight gain is not associated with exenatide, and patients in clinical studies dissipated an average of 4.9 lb (22 kg) from baseline above 30 weeks. (1-4)

In common study (5) comparing exenatide with insulin glargine (lantus), almost the same in 10 participants (9.7 percent) receiving exenatide dropp abroad because of adverse events compared with 07 percent of those receiving insulin glargine. mostly participants who dropped out did thus because of nausea (57 percent) or vomiting (17 percent)

Effectiveness

When used in combination with a sulfonylurea, metformin, or the pair exenatide produces a decrease in A1C of les than 1 percentage point. Between 24 and 46 percent of patients with an initial A1C of more than 7 percent (average 84 percent) will have an A1C of 7 percent or les after 30 weeks of therapy compared with 94 percent of patients receiving placebo (number stand in want ofed to treat = 3 to 7) (2-4) however, exenatide and insulin glargine each reduc A1C evens by an average of 11 percentage points, with 46 and 48 percent of patients, respectively, having an A1C of 7 percent or les after 26 weeks. (5)

Exenatide decreased fasting plasma grape-sugar levels by 5 to 10 mg for dL (0.3 to 0.6 mmol by L), whereas placebo was associated with slightly increased fasting plasma diabetic sugar levels. This improvement was not associated with weight gain. (2-4) In another investigation (5) the reduction in fasting plasma starch-sugar levels produced by exenatide was approximately united half that produced by insulin glargine (257 versus 515 mg through dL [1.4 versus 2.9 mmol by means of L], respectively).

Price

A prefilled compose with 60 doses of exenatide (one month supply) preciousnesss approximately $191 (5-mcg doses) or $223 (10-mcg doses). the same 10-mL vial of insulin glargine (100 U by mL) costs approximately $69 (not necessarily united month's supply). most prescription coverage plans disguise exenatide with no prior approval.

Simplicity

Exenatide is supplied as a sterile solution for subcutaneous injection containing 250 mcg by mL. It is available as a 12-mL prefilled pound (60 doses, 5 mcg for dose), and as a 24-mL prefilled indite (60 doses, 10 mcg by dose). The subcutaneous injection should be given in the thigh, abdomen, or upper arm. The compose requires refrigeration and protection from light, and should be discarded 30 days after first use. Initial dosage is 5 mcg subcutaneously twice daily within 60 minutes before the morning and evening meals. Exenatide should not be administered after meals. The dosage may be increased to 10 mcg twice daily after undivided month of therapy. When exenatide is added to metformin therapy, the present dosage of metformin may be continued. When it is added to a sulfonylurea, a dosage reduction of sulfonylurea should be considered to bring to the risk of hypoglycemia; however, no standard guidelines have been established.

Bottom Line

Exenatide is an injectable treatment for sign 2 diabetes. Its use requires patient education and strict monitoring of grape-sugar levels because of the difficulty of its administration; therefore, it may not be a safe or practical option for patients who are not willing or able to administer exenatide correctly. Exenatide is an expensive, inconvenient medicine that has no proven benefits athwart other drugs for diabetes management, including insulin.