Exenatide improves glycaemic control and body weight but has important side effects

A syringe

Exenatide is an injectable incretin-based drug treatment for type 2 diabetes belonging to the the class of glucagon-like peptide-1 (GLP-1) agonists.  One of its benefits is that it reduces body weight as well as glycaemia. NICE currently recommends exenatide as an add-on therapy where oral agents are not tolerated or ineffective.  This systematic review sought to collate all of the evidence on the safety and efficacy of weekly exenatide injections.

Clinical question

In type 2 diabetes, do weekly exenatide injections improve glycaemic control or cause adverse effects?

The reviewers were interested in exenatide used both as an add-on to existing therapy or as monotherapy.

The evidence

The review turned up six randomised controlled trials. The reviewers claim that this data showed that exenatide was effective at improving glycaemic control and reducing body weight.

However, they report that gastrointestinal side-effects are common, as are adverse reactions at the injection site.

Appraisal hints

Users of this research should consider:

  • This review seems to have a high risk of bias.
  • The literature search did not include EMBASE, and they only included English-language articles.  It’s likely that important evidence has been produced that was not included in the review.
  • It is not clear what differences were found between monotherapy and add-on therapy.
  • Did the reviewers attempt to carry out a meta-analysis?  With this type of research it is important to know much benefit exenatide gives so we can decide whether it is worth the risks and see how much uncertainty there is around it.
  • Longer term studies are needed to look at other important outcomes such as diabetes-related complications .
  • Other reviews looking at other outcomes, particularly quality of life and other patient-important outcomes.

Reference:

Murphy CE. Review of the Safety and Efficacy of Exenatide Once Weekly for the Treatment of Type 2 Diabetes Mellitus. Ann Pharmacother. 2012 Jun 5. [Epub ahead of print]

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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