Look for New GLP-1 Agonist and Flozin Options for Type 2 Diabetes

You'll see more players join the crowded field of type 2 diabetes meds...Bydureon BCise, Ozempic (oh-ZEM-pik), Steglatro (steh-GLAH-troh).

Bydureon BCise (exenatide ER) and Ozempic (semaglutide) will bring the total to eight GLP-1 agonists. Both are once-WEEKLY injections.

Bydureon BCise is extended-release exenatide, like Bydureon. You'll hear it gives more consistent drug levels in a simpler pen device.

But Bydureon BCise doesn't seem more effective than Bydureon...and must be shaken hard for at least 15 seconds to mix the med.

Ozempic is getting some buzz. You may hear it works better, but it lowers A1C by about 1.5%. This is similar to Victoza (liraglutide) and slightly more than some other GLP-1 agonists. It lowers weight by about 9 lb vs 3 to 6 lb with the others. And an ORAL form is in the pipeline.

Explain Ozempic may reduce CV risk in type 2s already at high CV risk...but doesn't seem to reduce overall or CV mortality like Victoza.

Ozempic is the only GLP-1 agonist with a warning about retinopathy complications...and risk is higher in patients who have retinopathy.

Ozempic costs about $675/month...versus $500 to $800 for the others.

Steglatro (ertugliflozin) will be the fourth "flozin" after Invokana (canagliflozin), Farxiga (dapagliflozin), and Jardiance (empagliflozin).

All of these SGLT2 inhibitors lower A1C about 0.7% to 1% and lead to about a 5 lb weight loss. Expect Steglatro to cost about $270/month... versus about $460 for the others. But it's too soon to say if Steglatro has the CV and mortality benefits seen with Jardiance.

Continue to recommend metformin first for type 2 diabetes. If an add-on is needed for CV patients, lean toward Victoza or Jardiance...they reduce both CV risk and CV death. But consider common side effects... nausea with GLP-1 agonists, yeast infections with flozins, etc.

For other patients, see our Drugs for Type 2 Diabetes chart to compare metformin add-ons based on cost, risk of hypoglycemia, etc.

And check out our new Diabetes Resource Hub for more charts...Diabetes Meds and CV Impact, Comparison of GLP-1 Agonists, and others.

Key References

  • Diabetes Care 2018;41(Suppl 1):S4-S6
  • Diabetes Obes Metab Published online Dec 21, 2017; doi:10.1111/dom.13194
  • N Engl J Med 2016;375(19):1834-44
  • N Engl J Med 2017;377(13):1228-39
  • Medication pricing by Elsevier, accessed Jan 2018
Pharmacist's Letter. Feb 2018, No. 340201

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