A 26-week, open-label, multi-center, randomized,
parallel-group trial sought to compare once weekly exenatide versus once daily liraglutide in
patients with type 2 diabetes. The results of the DURATION-6 trial were published in the January
12th issue of The Lancet in the article titled “Exenatide once weekly versus
liraglutide once daily in patients with type 2 diabetes (DURATION-6): a randomized, open-label
study”. Study authors hypothesized that once weekly exenatide would be at least non-inferior
and/or superior to once daily liraglutide in decreasing glycated hemoglobin (HbA1c) from
912 patients were randomized 1:1 to receive
either once daily liraglutide (1.8mg) or once weekly exenatide (2mg) for 26 weeks. All patients had
type 2 diabetes, uncontrolled by lifestyle modification and taking maximum or near maximum doses of
oral antihyperglycemic drugs. The primary outcome of the study was change in HbA1c from
baseline at 26 weeks. Results showed that once daily liraglutide decreased HbA1c more
than once weekly exenatide (-1.48% and -1.28%; p=0.02) and did not demonstrate non-inferiority for
once weekly exenatide (95% CI 0.08-0.33). However, both treatment groups did demonstrate a
clinically important decrease in HbA1c from baseline. 271 (60%) of subjects receiving
liraglutide and 243 (53%) of subjects receiving exenatide achieved HbA1c levels
< 7% (p=0.0011). The liraglutide treatment group also demonstrated greater weight loss
than the exenatide group (-3.57 and -2.68 kg, p=0.0005) in all patients regardless of body mass
index (BMI). Those receiving liraglutide experienced adverse events at a greater frequency than
those receiving exenatide; including nausea (21% and 9%), diarrhea (13% and 6%), headache (8% and
6%), and vomiting (11% and 4%).
Clinicians can use the results of this study when
evaluating treatment options for uncontrolled type 2 diabetic patients. Although once daily
liraglutide demonstrated a greater decrease in HbA1c and BMI than once weekly exenatide,
both drugs demonstrated clinically relevant improvements in glycemic control and weight loss.
Well-designed randomized controlled trials are needed to further evaluate this comparison. The pros and cons of each medication should be weighed on an
individual basis when choosing the best medication for the patient, including dosing frequency,
possible adverse effects, and cost.
- Buse JH, Nauck M, Forst T, et al.
Exenatide once weekly versus liraglutide once daily in patients with type 2 diabetes
(DURATION-6): a randomized, open-label study. The Lancet. Jan 12, 2013. 381:117-124.