Exenatide is better than placebo in type 2 diabetes not on insulin, at a cost

A syringe

This systematic review analysed all of the placebo-controlled studies of exenatide in the treatment of type 2 diabetes.

Clinical question:

In type 2 diabetes not on insulin, does exenatide improve glycaemic control, reduce weight or ha

The reviewers also looked at adverse events such as  nausea and hypoglycaemia.

The evidence:

Fourteen articles were found, comprising 2,583 participants.  The articles varied in their duration and dosage.  The reviewers combined the results in a meta-analysis and concluded that, compared with placebo, exenatide:

  • reduces HBA1c by 0.68% (95% CI: – 0.89 to -0.48) at 5μg and by -0.99% (-1.18 to -0.8) at 10μg
  • reduces body weight by 0.65kg (0.06 to 1.07) at 5μg and by1.24kg (0.78 to 1.69) at 10μg.  More weight loss was seen in longer duration studies.

It also reduces variation in fasting plasma glucose at both doses.

In terms of adverse events, exenatide was found to cause:

  • headache, at 5μg, with a relative risk of 2.4 (1.41 to 4.09) compared with placebo.
  • nausea and vomiting, at both 5μg and 10μg dosage levels.
  • hypoglycemia, at both 5μg and 10μg dosage levels.

Appraisal hints:

  • The literature search was limited to English language studies.  The reviewers did not search EMBASE.  Therefore, it’s likely that there is relevant research that they did not include.
  • The reviewers did not explore the impact of study quality, nor to they report on the quality of the studies they included.
  • There was significant heterogeneity between studies.
  • There were important differences between dosage levels.  This should be considered carefully.
  • Consider the patients subgroups who were enrolled in these studies.
  • Whilst it is important to gather such effectiveness data relative to placebo, it should be remembered that most type 2s will not be on a placebo intervention.

Reference:

Nikfar S, Abdollahi M, Salari P.  The efficacy and tolerability of exenatide in comparison to placebo; a systematic review and meta-analysis of randomized clinical trials. J Pharm Pharm Sci. 2012;15(1):1-30.

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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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