SA JOURNAL OF DIABETES & VASCULAR DISEASE
DRUG TRENDS
VOLUME 8 NUMBER 1 • MARCH 2011
41
may aid compliance, reduce polypharmacy and
are often more cost effective but unfortunately
they do not offer advantages over their initial
value’, he noted.
‘The incretins offer the promise of saving
β
-cells but until we use these agents earlier
in the treatment protocols, we will not realise
this for our patients. Cost is the barrier to early
use’, Dr Moore noted.
The once-a-week exenatide or even once-a-
month formulation, which are in clinical trials
at present, offer an interesting option, particu-
larly if nausea and gastrointestinal side effects
are lessened in these formulations. ‘Liraglutide,
a slightly modified version of the GLP-1 mol-
ecule, which is attached to albumin to extend
its pharmacokinetic profile over 24 hours and
with lower gastrointestinal side effects, will
be widely used if costs can be addressed’, Dr
Moore noted.
‘We do need outcome data for these medi-
cations, and the LifeLink database is beginning
to show that exenatide can reduce cardiovas-
cular events, mainly due to reductions in car-
diovascular-related hospitalisation’, Dr Moore
pointed out. ‘This is re-assuring.’
The DPP-4 inhibitors, such as sitagliptin
(Januvia) and saxagliptin from Astrazeneca,
have an advantage in reducing triglyceride
levels, which may prove to be of added value.
‘But again we do not yet have outcome data
on these new agents. Clinical outcome trials
are being done for some DPP-4s with our
South African centres participating’, Dr Moore
noted.
In conclusion, Dr Moore noted that none of
these oral therapies work well in patients who
do not adapt their lifestyle. ‘With adolescent
obesity and emerging type 2 diabetes occur-
ring in the 20-year-old, we will have cardiovas-
cular consequences much earlier, in the 30- to
40-year age group for example. This presents
a significant challenge to healthcare systems
worldwide.
J Aalbers, Special Assignment Editor
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