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SAN FRANCISCO – A once-daily subcutaneous injection of an experimental 3-mg dose of liraglutide was significantly more effective than the approved 1.8-mg dose or placebo for weight loss in a randomized, double-blind study of 846 overweight or obese adults with diabetes.
All treatment arms also employed caloric reduction and exercise for weight management. After 56 weeks of therapy, body weight decreased by 5.9% in the 3-mg group, 4.6% in the 1.8-mg group, and 2% in patients on placebo. The mean changes in both liraglutide groups were significantly better than on placebo, and the greater loss on 3 mg, compared with 1.8 mg of liraglutide, also was statistically significant, Dr. Melanie Davies and her associates reported at the annual scientific sessions of the American Diabetes Association.
The percentages of patients who lost at least 5% of body weight by 56 weeks were 50% in the 3-mg group, 36% in the 1.8-mg group, and 14% on placebo. Again, liraglutide at either dose was significantly more effective than placebo, and the higher dose of liraglutide worked significantly better than the lower dose, reported Dr. Davies, professor of diabetes medicine at the University of Leicester (England).
The percentages of patients who lost at least 10% of body weight were 23% in the 3-mg group, 14% in the 1.8-mg group, and 4% on placebo. The same statistical trends were seen, with the higher dose being significantly more effective.
Among secondary outcomes in the SCALE-Diabetes trial (Effect of Liraglutide on Body Weight in Overweight or Obese Subjects with Type 2 Diabetes), greater reductions were seen in hemoglobin A1c levels after 56 weeks on the higher drug dose. HbA1c levels fell by 1.3% on the 3-mg dose, compared with 1.1% on the 1.8-mg dose or 0.3% on placebo, Dr. Davies said.
The proportions of patients achieving an HbA1c level of 6.5% or lower were 57% in the 3-mg group, 46% in the 1.8-mg group, and 15% on placebo. The proportions of patients achieving an HbA1c level below 7% were 69% in the 3-mg group, 67% in the 1.8-mg group, and 27% in the placebo group. Fasting glucose levels decreased by 34 mg/dL in the 3-mg group, 25 mg/dL in the 1.8-mg group, and 2 mg/dL on placebo. In each case, the 3-mg dose was more effective than the lower dose or placebo, except that the likelihood of getting HbA1c below 7% was not significantly different between the 3-mg and 1.8-mg liraglutide groups.
Systolic blood pressure measurements decreased by a mean of 3.5 mmHg in the 3-mg group, 2.8 mmHg in the 1.8-mg group, and 0.4 mmHg in the placebo group.
Thirty-four percent in the 3-mg group withdrew before the end of the study, as did 22% in the 1.8-mg group and 23% on placebo.
Rates of side effects were not significantly different between the two liraglutide groups, except for gastrointestinal events, Dr. Davies said. Adverse events were seen in 93% on 3 mg liraglutide, 90% on the 1.8-mg dose, and 86% on placebo. Serious adverse events occurred in 9% in either liraglutide group and in 6% on placebo, and side effects led to withdrawal from the study in 9% of either drug group and in 3% on placebo. Severe episodes of adverse events occurred in 12% in the 3-mg group, 14% in the 1.8-mg group, and 10% on placebo. One death in the 1.8-mg group that occurred after the study ended was not considered to be related to treatment, she said.
The most common side effects were nausea (in 33% on 3 mg, 31% on 1.8 mg, and 14% on placebo), diarrhea (26%, 18%, and 13%, respectively), constipation (16%, 10%, and 6%, respectively), and vomiting (16%, 10%, and 6%, respectively). Most of the increase in nausea among those on the drug resolved by 24 weeks.
Hypoglycemia occurred in 44% of the 3-mg group, 40% of the 1.8-mg group, and 28% in the placebo group and was more common in patients on liraglutide and in patients who also were taking sulfonylurea drugs, she said.
A separate SCALE study in 3,731 nondiabetic patients (Effect of Liraglutide on Body Weight in Non-diabetic Obese Subjects or Overweight Subjects with Comorbidities) found that the 3-mg dose was more effective for weight loss than placebo in adults without diabetes. Although that study detected rates of pancreatitis and gallbladder disorders that were more than twice as common (though still rare) with liraglutide, compared with placebo, there were no episodes of pancreatitis in the current trial, Dr. Davies said. There was no difference in levels of amylase, which is a marker of pancreatitis, between the two drug arms.
Increased lipase levels were seen in 12% on the 3-mg dose, 10% on the 1.8-mg dose, and 7% on placebo, she said. The drug groups showed roughly a 10-unit increase in lipase that occurred early and was maintained during the duration of the study.
"Obviously, there are still some concerns around pancreatitis with GLP1 drugs as a class, but certainly in this study there were no cases of pancreatitis," Dr. Davies said. Only eight patients developed gallstones in the current study, too few to compare rates between groups, she added.
Liraglutide, in formulations of 1.2 mg and 1.8 mg for daily injections, was approved in 2010 for the treatment of type 2 diabetes and is marketed in those doses as Victoza.
Dr. Davies reported having financial associations with Novo Nordisk, which manufactures liraglutide, and with eight other pharmaceutical companies.
On Twitter @sherryboschert
The take-home message is that this study shows liraglutide 3 mg is effective in terms of weight loss in obese and overweight adults with type 2 diabetes. There also was a beneficial effect on HbA1c. It appeared that the higher dose of 3 mg had even better effects than the currently approved 1.8-mg dose on weight and on HbA1c in this particular patient group. The side effect profile appeared to be similar to the 1.8-mg dose. The 3-mg dose seemed to be safe.
If the 3-mg dose was indicated and licensed, I think it would be entirely reasonable to use it, particularly in the morbidly obese population with type 2 diabetes, because you get a better effect in terms of HbA1c reduction and weight loss.
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Whenever you’re increasing a dose with any medication, there’s always a concern about promotion of side effects. In this study, it appeared that the higher dose was tolerated really well. There didn’t seem to be a big difference between the 3-mg and 1.8-mg dose in that regard. That’s kind of reassuring for physicians when considering a higher dose.
There are other treatment options, including the SGLT2 (sodium glucose co-transporter 2) inhibitors, which are orally administered and also can promote weight loss by a completely different mechanism. SGLT2 inhibitors are indicated for patients with type 2 diabetes who have poor control. A plus is that they can be orally administered.
If you look at diabetes therapies in general, things like sulfonylureas, thiazolidinediones, and insulin promote weight gain. That’s a big problem because that makes insulin resistance worse. Having a diabetes therapy that can also promote weight loss is hugely beneficial. As a diabetologist, I put huge value on a drug that promotes weight loss in this context. I think we now have two major groups – the GLP1 (glucagon-like peptide 1) agents, of which liraglutide is one, and the SGLT2 inhibitors – both of which can achieve that. I think it’s a very useful addition to our armamentarium and management.
Thomas Barber, M.D., is associate professor and honorary consultant endocrinologist at the University of Warwick, England. He gave these comments in an interview at the meeting. Dr. Barber reported having no financial disclosures.
The take-home message is that this study shows liraglutide 3 mg is effective in terms of weight loss in obese and overweight adults with type 2 diabetes. There also was a beneficial effect on HbA1c. It appeared that the higher dose of 3 mg had even better effects than the currently approved 1.8-mg dose on weight and on HbA1c in this particular patient group. The side effect profile appeared to be similar to the 1.8-mg dose. The 3-mg dose seemed to be safe.
If the 3-mg dose was indicated and licensed, I think it would be entirely reasonable to use it, particularly in the morbidly obese population with type 2 diabetes, because you get a better effect in terms of HbA1c reduction and weight loss.
|
|
Whenever you’re increasing a dose with any medication, there’s always a concern about promotion of side effects. In this study, it appeared that the higher dose was tolerated really well. There didn’t seem to be a big difference between the 3-mg and 1.8-mg dose in that regard. That’s kind of reassuring for physicians when considering a higher dose.
There are other treatment options, including the SGLT2 (sodium glucose co-transporter 2) inhibitors, which are orally administered and also can promote weight loss by a completely different mechanism. SGLT2 inhibitors are indicated for patients with type 2 diabetes who have poor control. A plus is that they can be orally administered.
If you look at diabetes therapies in general, things like sulfonylureas, thiazolidinediones, and insulin promote weight gain. That’s a big problem because that makes insulin resistance worse. Having a diabetes therapy that can also promote weight loss is hugely beneficial. As a diabetologist, I put huge value on a drug that promotes weight loss in this context. I think we now have two major groups – the GLP1 (glucagon-like peptide 1) agents, of which liraglutide is one, and the SGLT2 inhibitors – both of which can achieve that. I think it’s a very useful addition to our armamentarium and management.
Thomas Barber, M.D., is associate professor and honorary consultant endocrinologist at the University of Warwick, England. He gave these comments in an interview at the meeting. Dr. Barber reported having no financial disclosures.
The take-home message is that this study shows liraglutide 3 mg is effective in terms of weight loss in obese and overweight adults with type 2 diabetes. There also was a beneficial effect on HbA1c. It appeared that the higher dose of 3 mg had even better effects than the currently approved 1.8-mg dose on weight and on HbA1c in this particular patient group. The side effect profile appeared to be similar to the 1.8-mg dose. The 3-mg dose seemed to be safe.
If the 3-mg dose was indicated and licensed, I think it would be entirely reasonable to use it, particularly in the morbidly obese population with type 2 diabetes, because you get a better effect in terms of HbA1c reduction and weight loss.
|
|
Whenever you’re increasing a dose with any medication, there’s always a concern about promotion of side effects. In this study, it appeared that the higher dose was tolerated really well. There didn’t seem to be a big difference between the 3-mg and 1.8-mg dose in that regard. That’s kind of reassuring for physicians when considering a higher dose.
There are other treatment options, including the SGLT2 (sodium glucose co-transporter 2) inhibitors, which are orally administered and also can promote weight loss by a completely different mechanism. SGLT2 inhibitors are indicated for patients with type 2 diabetes who have poor control. A plus is that they can be orally administered.
If you look at diabetes therapies in general, things like sulfonylureas, thiazolidinediones, and insulin promote weight gain. That’s a big problem because that makes insulin resistance worse. Having a diabetes therapy that can also promote weight loss is hugely beneficial. As a diabetologist, I put huge value on a drug that promotes weight loss in this context. I think we now have two major groups – the GLP1 (glucagon-like peptide 1) agents, of which liraglutide is one, and the SGLT2 inhibitors – both of which can achieve that. I think it’s a very useful addition to our armamentarium and management.
Thomas Barber, M.D., is associate professor and honorary consultant endocrinologist at the University of Warwick, England. He gave these comments in an interview at the meeting. Dr. Barber reported having no financial disclosures.
SAN FRANCISCO – A once-daily subcutaneous injection of an experimental 3-mg dose of liraglutide was significantly more effective than the approved 1.8-mg dose or placebo for weight loss in a randomized, double-blind study of 846 overweight or obese adults with diabetes.
All treatment arms also employed caloric reduction and exercise for weight management. After 56 weeks of therapy, body weight decreased by 5.9% in the 3-mg group, 4.6% in the 1.8-mg group, and 2% in patients on placebo. The mean changes in both liraglutide groups were significantly better than on placebo, and the greater loss on 3 mg, compared with 1.8 mg of liraglutide, also was statistically significant, Dr. Melanie Davies and her associates reported at the annual scientific sessions of the American Diabetes Association.
The percentages of patients who lost at least 5% of body weight by 56 weeks were 50% in the 3-mg group, 36% in the 1.8-mg group, and 14% on placebo. Again, liraglutide at either dose was significantly more effective than placebo, and the higher dose of liraglutide worked significantly better than the lower dose, reported Dr. Davies, professor of diabetes medicine at the University of Leicester (England).
The percentages of patients who lost at least 10% of body weight were 23% in the 3-mg group, 14% in the 1.8-mg group, and 4% on placebo. The same statistical trends were seen, with the higher dose being significantly more effective.
Among secondary outcomes in the SCALE-Diabetes trial (Effect of Liraglutide on Body Weight in Overweight or Obese Subjects with Type 2 Diabetes), greater reductions were seen in hemoglobin A1c levels after 56 weeks on the higher drug dose. HbA1c levels fell by 1.3% on the 3-mg dose, compared with 1.1% on the 1.8-mg dose or 0.3% on placebo, Dr. Davies said.
The proportions of patients achieving an HbA1c level of 6.5% or lower were 57% in the 3-mg group, 46% in the 1.8-mg group, and 15% on placebo. The proportions of patients achieving an HbA1c level below 7% were 69% in the 3-mg group, 67% in the 1.8-mg group, and 27% in the placebo group. Fasting glucose levels decreased by 34 mg/dL in the 3-mg group, 25 mg/dL in the 1.8-mg group, and 2 mg/dL on placebo. In each case, the 3-mg dose was more effective than the lower dose or placebo, except that the likelihood of getting HbA1c below 7% was not significantly different between the 3-mg and 1.8-mg liraglutide groups.
Systolic blood pressure measurements decreased by a mean of 3.5 mmHg in the 3-mg group, 2.8 mmHg in the 1.8-mg group, and 0.4 mmHg in the placebo group.
Thirty-four percent in the 3-mg group withdrew before the end of the study, as did 22% in the 1.8-mg group and 23% on placebo.
Rates of side effects were not significantly different between the two liraglutide groups, except for gastrointestinal events, Dr. Davies said. Adverse events were seen in 93% on 3 mg liraglutide, 90% on the 1.8-mg dose, and 86% on placebo. Serious adverse events occurred in 9% in either liraglutide group and in 6% on placebo, and side effects led to withdrawal from the study in 9% of either drug group and in 3% on placebo. Severe episodes of adverse events occurred in 12% in the 3-mg group, 14% in the 1.8-mg group, and 10% on placebo. One death in the 1.8-mg group that occurred after the study ended was not considered to be related to treatment, she said.
The most common side effects were nausea (in 33% on 3 mg, 31% on 1.8 mg, and 14% on placebo), diarrhea (26%, 18%, and 13%, respectively), constipation (16%, 10%, and 6%, respectively), and vomiting (16%, 10%, and 6%, respectively). Most of the increase in nausea among those on the drug resolved by 24 weeks.
Hypoglycemia occurred in 44% of the 3-mg group, 40% of the 1.8-mg group, and 28% in the placebo group and was more common in patients on liraglutide and in patients who also were taking sulfonylurea drugs, she said.
A separate SCALE study in 3,731 nondiabetic patients (Effect of Liraglutide on Body Weight in Non-diabetic Obese Subjects or Overweight Subjects with Comorbidities) found that the 3-mg dose was more effective for weight loss than placebo in adults without diabetes. Although that study detected rates of pancreatitis and gallbladder disorders that were more than twice as common (though still rare) with liraglutide, compared with placebo, there were no episodes of pancreatitis in the current trial, Dr. Davies said. There was no difference in levels of amylase, which is a marker of pancreatitis, between the two drug arms.
Increased lipase levels were seen in 12% on the 3-mg dose, 10% on the 1.8-mg dose, and 7% on placebo, she said. The drug groups showed roughly a 10-unit increase in lipase that occurred early and was maintained during the duration of the study.
"Obviously, there are still some concerns around pancreatitis with GLP1 drugs as a class, but certainly in this study there were no cases of pancreatitis," Dr. Davies said. Only eight patients developed gallstones in the current study, too few to compare rates between groups, she added.
Liraglutide, in formulations of 1.2 mg and 1.8 mg for daily injections, was approved in 2010 for the treatment of type 2 diabetes and is marketed in those doses as Victoza.
Dr. Davies reported having financial associations with Novo Nordisk, which manufactures liraglutide, and with eight other pharmaceutical companies.
On Twitter @sherryboschert
SAN FRANCISCO – A once-daily subcutaneous injection of an experimental 3-mg dose of liraglutide was significantly more effective than the approved 1.8-mg dose or placebo for weight loss in a randomized, double-blind study of 846 overweight or obese adults with diabetes.
All treatment arms also employed caloric reduction and exercise for weight management. After 56 weeks of therapy, body weight decreased by 5.9% in the 3-mg group, 4.6% in the 1.8-mg group, and 2% in patients on placebo. The mean changes in both liraglutide groups were significantly better than on placebo, and the greater loss on 3 mg, compared with 1.8 mg of liraglutide, also was statistically significant, Dr. Melanie Davies and her associates reported at the annual scientific sessions of the American Diabetes Association.
The percentages of patients who lost at least 5% of body weight by 56 weeks were 50% in the 3-mg group, 36% in the 1.8-mg group, and 14% on placebo. Again, liraglutide at either dose was significantly more effective than placebo, and the higher dose of liraglutide worked significantly better than the lower dose, reported Dr. Davies, professor of diabetes medicine at the University of Leicester (England).
The percentages of patients who lost at least 10% of body weight were 23% in the 3-mg group, 14% in the 1.8-mg group, and 4% on placebo. The same statistical trends were seen, with the higher dose being significantly more effective.
Among secondary outcomes in the SCALE-Diabetes trial (Effect of Liraglutide on Body Weight in Overweight or Obese Subjects with Type 2 Diabetes), greater reductions were seen in hemoglobin A1c levels after 56 weeks on the higher drug dose. HbA1c levels fell by 1.3% on the 3-mg dose, compared with 1.1% on the 1.8-mg dose or 0.3% on placebo, Dr. Davies said.
The proportions of patients achieving an HbA1c level of 6.5% or lower were 57% in the 3-mg group, 46% in the 1.8-mg group, and 15% on placebo. The proportions of patients achieving an HbA1c level below 7% were 69% in the 3-mg group, 67% in the 1.8-mg group, and 27% in the placebo group. Fasting glucose levels decreased by 34 mg/dL in the 3-mg group, 25 mg/dL in the 1.8-mg group, and 2 mg/dL on placebo. In each case, the 3-mg dose was more effective than the lower dose or placebo, except that the likelihood of getting HbA1c below 7% was not significantly different between the 3-mg and 1.8-mg liraglutide groups.
Systolic blood pressure measurements decreased by a mean of 3.5 mmHg in the 3-mg group, 2.8 mmHg in the 1.8-mg group, and 0.4 mmHg in the placebo group.
Thirty-four percent in the 3-mg group withdrew before the end of the study, as did 22% in the 1.8-mg group and 23% on placebo.
Rates of side effects were not significantly different between the two liraglutide groups, except for gastrointestinal events, Dr. Davies said. Adverse events were seen in 93% on 3 mg liraglutide, 90% on the 1.8-mg dose, and 86% on placebo. Serious adverse events occurred in 9% in either liraglutide group and in 6% on placebo, and side effects led to withdrawal from the study in 9% of either drug group and in 3% on placebo. Severe episodes of adverse events occurred in 12% in the 3-mg group, 14% in the 1.8-mg group, and 10% on placebo. One death in the 1.8-mg group that occurred after the study ended was not considered to be related to treatment, she said.
The most common side effects were nausea (in 33% on 3 mg, 31% on 1.8 mg, and 14% on placebo), diarrhea (26%, 18%, and 13%, respectively), constipation (16%, 10%, and 6%, respectively), and vomiting (16%, 10%, and 6%, respectively). Most of the increase in nausea among those on the drug resolved by 24 weeks.
Hypoglycemia occurred in 44% of the 3-mg group, 40% of the 1.8-mg group, and 28% in the placebo group and was more common in patients on liraglutide and in patients who also were taking sulfonylurea drugs, she said.
A separate SCALE study in 3,731 nondiabetic patients (Effect of Liraglutide on Body Weight in Non-diabetic Obese Subjects or Overweight Subjects with Comorbidities) found that the 3-mg dose was more effective for weight loss than placebo in adults without diabetes. Although that study detected rates of pancreatitis and gallbladder disorders that were more than twice as common (though still rare) with liraglutide, compared with placebo, there were no episodes of pancreatitis in the current trial, Dr. Davies said. There was no difference in levels of amylase, which is a marker of pancreatitis, between the two drug arms.
Increased lipase levels were seen in 12% on the 3-mg dose, 10% on the 1.8-mg dose, and 7% on placebo, she said. The drug groups showed roughly a 10-unit increase in lipase that occurred early and was maintained during the duration of the study.
"Obviously, there are still some concerns around pancreatitis with GLP1 drugs as a class, but certainly in this study there were no cases of pancreatitis," Dr. Davies said. Only eight patients developed gallstones in the current study, too few to compare rates between groups, she added.
Liraglutide, in formulations of 1.2 mg and 1.8 mg for daily injections, was approved in 2010 for the treatment of type 2 diabetes and is marketed in those doses as Victoza.
Dr. Davies reported having financial associations with Novo Nordisk, which manufactures liraglutide, and with eight other pharmaceutical companies.
On Twitter @sherryboschert
AT THE ADA ANNUAL SCIENTIFIC SESSIONS
Key clinical point: An investigational 3-mg/day dose of liraglutide may be more effective than 1.8 mg for weight loss in diabetes.
Major finding: Patients on 3 mg/day of liraglutide lost 5.9% of body weight, compared with losses of 4.6% on 1.8 mg/day or 2% on placebo, after 56 weeks of therapy.
Data source: A prospective, randomized, double-blind, placebo-controlled trial of 3 mg or 1.8 mg liraglutide or placebo as adjuncts to diet and exercise in 846 overweight or obese adults with type 2 diabetes.
Disclosures: Dr. Davies reported having financial associations with Novo Nordisk, which manufactures liraglutide, and with eight other pharmaceutical companies.
