Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD).

Abstract

OBJECTIVE:

To determine the efficacy and safety of liraglutide (a glucagon-like peptide-1 receptor agonist) when added to metformin and rosiglitazone in type 2 diabetes.

RESEARCH DESIGN AND METHODS:

This 26-week, double-blind, placebo-controlled, parallel-group trial randomized 533 subjects (1:1:1) to once-daily liraglutide (1.2 or 1.8 mg) or liraglutide placebo in combination with metformin (1 g twice daily) and rosiglitazone (4 mg twice daily). Subjects had type 2 diabetes, A1C 7-11% (previous oral antidiabetes drug [OAD] monotherapy >or=3 months) or 7-10% (previous OAD combination therapy >or=3 months), and BMI <or=45 kg/m(2).

RESULTS:

Mean A1C values decreased significantly more in the liraglutide groups versus placebo (mean +/- SE -1.5 +/- 0.1% for both 1.2 and 1.8 mg liraglutide and -0.5 +/- 0.1% for placebo). Fasting plasma glucose decreased by 40, 44, and 8 mg/dl for 1.2 and 1.8 mg and placebo, respectively, and 90-min postprandial glucose decreased by 47, 49, and 14 mg/dl, respectively (P < 0.001 for all liraglutide groups vs. placebo). Dose-dependent weight loss occurred with 1.2 and 1.8 mg liraglutide (1.0 +/- 0.3 and 2.0 +/- 0.3 kg, respectively) (P < 0.0001) compared with weight gain with placebo (0.6 +/- 0.3 kg). Systolic blood pressure decreased by 6.7, 5.6, and 1.1 mmHg with 1.2 and 1.8 mg liraglutide and placebo, respectively. Significant increases in C-peptide and homeostasis model assessment of beta-cell function and significant decreases in the proinsulin-to-insulin ratio occurred with liraglutide versus placebo. Minor hypoglycemia occurred more frequently with liraglutide, but there was no major hypoglycemia. Gastrointestinal adverse events were more common with liraglutide, but most occurred early and were transient.

CONCLUSIONS:

Liraglutide combined with metformin and a thiazolidinedione is a well-tolerated combination therapy for type 2 diabetes, providing significant improvements in glycemic control.

• Authors: Bernard Zinman, John Gerich, John B Buse, Andrew Lewin, Sherwyn Schwartz, Philip Raskin, Paula M Hale, Milan Zdravkovic, Lawrence Blonde, LEAD-4 Study Investigators
• Journal: Diabetes care (Diabetes Care) Vol. 32 Issue 7 Pg. 1224-30 (Jul 2009) ISSN: 1935-5548 [Electronic] United States
• PMID: 19289857 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Placebos
• Thiazolidinediones
• Liraglutide
• Glucagon-Like Peptide 1
• Metformin

Topics

• Adolescent
• Adult
• Aged
• Blood Glucose (drug effects, metabolism)
• Blood Pressure (drug effects)
• Diabetes Mellitus, Type 2 (drug therapy)
• Double-Blind Method
• Drug Therapy, Combination
• Fasting
• Glucagon-Like Peptide 1 (analogs & derivatives, therapeutic use)
• Glycated Hemoglobin (drug effects, metabolism)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Liraglutide
• Metformin (therapeutic use)
• Middle Aged
• Placebos
• Safety
• Thiazolidinediones (therapeutic use)
• Young Adult