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News: Prescriber's Letter August 2014

Tanzeum (TAN-zee-um, albiglutide) will be another GLP-1 agonist for diabetes...after Byetta, Victoza, and Bydureon.

These injectables will continue to gain popularity because they cause weight loss...and are unlikely to cause hypoglycemia. 

Pick one based on their pros and cons...and patient preference.

A1C lowering is about 1% with Tanzeum or Byetta (exenatide)... 1.3% with Bydureon (exenatide ER)...and 1.5% with Victoza (liraglutide). 

Weight loss is least with Tanzeum.  Tell patients to expect about a 1 to 2 pound drop with Tanzeum...compared to 6 pounds with the others.

Convenience depends on what is important to the patient. 

Use Bydureon or Tanzeum for less frequent dosing.  They’re given once weekly...instead of once daily for Victoza or BID for Byetta

On the other hand, Victoza and Byetta pens don’t need mixing. 

Tanzeum and Bydureon need to be reconstituted first.  But expect a new Bydureon pen later this year that will be easier for the patient to mix than the current vial and syringe version.

Side effects are similar...but severity varies.  Tanzeum and Bydureon seem to cause LESS nausea...but MORE injection site reactions.

All agents are linked to pancreatitis...but this is rare.

Cost is least with Tanzeum.  It’s about $325/month...compared to over $400 for Bydureon or Byetta...and almost $600 for high-dose Victoza.

Continue to use metformin first for most type 2s.

Consider a GLP-1 agonist as an alternative to insulin for patients on 2 or 3 oral agents...especially if A1C is within 1.5% of goal. 

For example, adding Bydureon to metformin may lower A1C slightly more than once-daily Lantus...and lead to weight loss instead of weight gain.  But GI side effects are more common with Bydureon.

Keep in mind that insulin or sulfonylurea doses may need to be reduced when a GLP-1 agonist is reduce hypoglycemia risk.

To hear our team discuss the differences among these meds and when to use them, go to our PL Detail-Document and click on PL VOICES.

Also see our PL Chart, Comparison of GLP-1 Agonists, for dosing, A1C lowering, cost, and side effects.

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