Aims: Many patients stop exenatide due to gastrointestinal (GI) side effects or lack of efficacy. DPPIV inhibitors generally achieve less HbA1c and weight reduction than GLP-1 agonist treatment. The effects of switching exenatide or DPPIV inhibitors to liraglutide are examined in the ABCD nationwide liraglutide audit.
Methods: 65 centres across UK submitted anonymised data on 3010 patients started on liraglutide in clinical practice. Patients in the audit were divided into those who were on exenatide (Group 1), on DPPIV inhibitors (Group 2) or not on incretin-based therapy (Group 3). Within and across group 3 month HbA1c and weight changes were assessed using paired t-tests and ANOVA. Changes were also assessed among subgroups of Group 1 depending on reasons for discontinuing exenatide. Rates of gastrointestinal (GI) side effects and liraglutide discontinuation were assessed.
Results: Baseline characteristics were 53.5% male, 89.5% Caucasian, mean±(SD) age 55.4±11.1 years, HbA1c 9.28±1.73%, BMI 38.9±7.3 kg/m2 and median (interquartile range) diabetes duration 9 (6-13) years. Group 1, 2 and 3 had 707/3010 (23.5%), 317/3010 (10.5%) and 1986/3010 (66.0%) patients. All HbA1c and weight comparisons with baseline were significant (all p<0.001). Group 1, 2 and 3 achieved mean±SE HbA1c reduction of 0.60±0.10, 0.75±0.14 and 1.10±0.06%. Mean weight reduction were 1.2±0.3, 2.8±0.3 and 3.1±0.2 kg. Group 1 achieved less HbA1c and weight reduction than Group 3 (both p<0.001), and less weight reduction than Group 2 (p<0.05). Patients among Group 1 who stopped exenatide due to GI side effects achieved significant HbA1c and weight reduction (0.67±0.31%, p=0.043, 2.1±0.6 kg, p=0.001) but not those who stopped exenatide due to lack of efficacy or problems with compliance. 13.2, 16.7 and 16.3% of Group 1, 2 and 3 suffered GI side effects after liraglutide treatment (difference, p=0.118). 16.1% of patients who stopped exenatide due to GI side effects had GI side effects after liraglutide treatment. Liraglutide discontinuation were 13.6, 9.8, 10.4% (difference, p=0.053) all at median of 14 weeks respectively.
Conclusion: Patients switching from exenatide to liraglutide achieved less HbA1c and weight reduction than patients not previously on incretin-based therapy. However, liraglutide was able to significantly improve HbA1c and weight in patients who otherwise failed exenatide therapy due to GI side effects.
