Liraglutide: A Review of the First Once-Daily GLP-1 Receptor Agonist

Liraglutide is an analog with 97% homology to human glucagon-like peptide (GLP-1) and acts as a GLP-1 receptor agonist. Several large, randomized, multicenter phase 3 trials evaluated the efficacy and safety of liraglutide by comparing monotherapy and combination therapy with other antidiabetic medications in adult patients with type 2 diabetes. The Liraglutide Effect and Action in Diabetes (LEAD) program demonstrated that liraglutide, when used alone or in combination with other antidiabetic medications, effectively controls hyperglycemia (glycosylated hemoglobin [A1C] reductions up to 1.6%) and assists patients in meeting established glycemic targets. Compared with certain other classes of antidiabetic agents, liraglutide is associated with a lower risk of hypoglycemia. Liraglutide has also been associated with weight loss (1.8 to 3.4 kg) and improved patient satisfaction and health-related quality of life. Several studies have demonstrated that GLP-1 receptor agonists may improve pancreatic beta cell function, which may delay disease progression if maintained over the long term. As with any drug, liraglutide is not without risk, and a patient's complete clinical status and benefit-to-risk profile should be considered before prescribing treatment. For patients with type 2 diabetes who have failed to achieve glycemic control through diet and exercise, liraglutide may be an important treatment option. The current consensus statement of the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) cites efficacy and low risk of hypoglycemia in preferring GLP-1 agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors over sulfonylureas and glinides, after initial treatment with metformin. The guidelines prefer GLP-1 agonists over DPP-4 inhibitors because of their actions that promote weight loss and their somewhat greater effectiveness in reducing postprandial glucose excursions. (Am J Manag Care. 2011; 17: S59-S70)