The GLP-1 receptor agonist lixisenatide is indicated as adjunctive therapy for adults with type 2-diabetes when oral antidiabetics and/or basal insulin, along with diet and exercise, does not provide adequate glycaemic control.
Compared to placebo a clinically relevant reduction in HbA1c was seen for lixisenatide as adjunctive therapy to sulfonylureas (SU) or basal insulin ± SU after 24 weeks of treatment. The clinical relevance as add-on to metformin alone or whether lixisenatide is as effective as exenatide and liraglutide remains unclear.
The most frequently occurring adverse events are nausea, vomiting, and diarrhea. Lixisenatide causes relatively fewer hypoglycaemic episodes than exenatide twice daily when used as add-on to metformin. As with other GLP-1 analogues there is a suspected risk of acute pancreatitis and C-cell thyroid cancer.
It is IRF’s overall assessment that there are no clear clinical advantages for using lixisenatide over exenatide or liraglutide. Accordingly, there is not a logical first-line choice within this drug group. Prescribing a GLP-1 analogue should therefore be based on an individual assessment of risk factors, patient profile and preferences as well as practical conditions.
Lyxumia was marketed April 15th 2013. It is subject to general reimbursement.