Commentary: Exenatide QW: A New Treatment Option for Type 2 Diabetes Offering Ease of Use, Improved Efficacy, and Reduced Side Effects

Exenatide once weekly (QW) has recently been introduced for weekly subcutaneous injection as an adjunct to diet and lifestyle change for the treatment of type 2 diabetes. It is the first weekly diabetes therapy to come to market and offers a number of interesting possibilities for clinicians and patients.

Although this treatment is, at its core, the exenatide molecule that has been known for more than a decade and has been in widespread clinical use for at least 7 years,¹ exenatide QW has a unique microsphere encapsulation.² This feature delays absorption, thus producing continuous steady-state levels of exenatide in the bloodstream, which leads to lower A1C levels and greater weight loss than exenatide's twice-daily formulation³ and a lower incidence of side effects than other glucagon-like peptide-1 (GLP-1) receptor agonists (also called incretin mimetics) currently in use.^3,4

Validation of the acceptance in clinical practice of GLP-1 receptor agonists can be found in the recently released American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) position statement on the management of type 2 diabetes, which placed these drugs alongside older, well-accepted agents such as sulfonylureas (SUs) and thiozolidinediones (TZDs) as a second-line therapy after metformin.⁵

GLP-1 receptor agonists are described as having high efficacy and a low risk of hypoglycemia and as being on a cost tier (high) equal to other add-on agents except for SUs (low) and insulin (variable).⁵ GLP-1 receptor agonists are the only class mentioned with which weight loss is expected.⁵ Although gastrointestinal (GI) issues were cited as side effects with this class, exenatide QW has a lower incidence of these side effects than other available GLP-1 receptor agonists.^3,4