Unlike typical Western patients, type 2 diabetes patients in Asia tend to have lower BMIs. Does this mean responses to GLP-1 RAs differ as well?
A pooled analysis comparing the effects of exenatide twice daily and exenatide once weekly in Asian and white patients has shown that although both drugs effectively improved glycemic control, the twice daily regimen resulted in greater HbA1c reduction in Asian patients.
“Patients from different genetic or cultural backgrounds may have different pathophysiological defects in type 2 diabetes, and this analysis supports that hypothesis,” wrote researcher Wayne H. Sheu, of Taichung Veterans General Hospital, Taiwan, and colleagues, in Diabetes Research and Clinical Practice. “Upon treatment with exenatide twice daily or once weekly, the Asian population appeared to have significantly greater HbA1c reduction (twice daily only), greater post-prandial glucose reduction (twice daily only), smaller weight loss and fewer reports of nausea.”
According to the study, type 2 diabetes in Asian countries typically occurs in patients with lower body mass index and in young or middle-aged adults as compared with Western countries where the disease is more common in overweight adults or those in advanced age. In addition, compared with fasting glucose, post-prandial glucose seems to be more influential in Asian patients compared with white patients. With these differences in mind, in this pooled analysis, Sheu and colleagues wanted to assess the safety and efficacy of exenatide twice daily and once weekly in these two populations.
They pooled patient-level data from 29 selected studies in the exenatide global integrated database that included 4625 patients. Patients in these studies were assigned to either a twice daily regimen (Asian, n=787; white, n=2223) or once weekly regimen (Asian, n=551; white, n=1104). At baseline, the Asian patients in these studies had significantly lower body weight, higher HbA1c, and lower fasting glucose compared with white patients.
After on-study treatment with exenatide, patients had significant reductions in HbA1c, fasting glucose, body weight, and post-prandial glucose (P<0.0001 for all). However, the data indicated that there was a greater reduction in HbA1c and post-prandial glucose in Asian patients assigned to the twice daily regimen compared with white patients (P<0.0001 for both).
White patients on either dose had significantly greater reduction in weight compared with Asian patients, which the researchers wrote “may reflect the higher baseline body weight in White patients.”
Overall safety was similar between the two populations. Nausea was the most commonly reported adverse effect seen with either formulation of exenatide; however, nausea was reported less frequently among Asian patients compared with white patients.
“Alongside data from randomized, controlled, global clinical trials in mixed populations, this post-hoc analysis supports the conclusion that exenatide twice daily or once weekly is an appropriate treatment option when Asian patients with type 2 diabetes are considered suitable for injectable therapy (including those patients who are failing oral glucose-lowering drugs),” the researchers wrote. “Longer term, real-world observations and assessments may determine if multiple benefits from use of exenatide-including HbA1c, post-prandial glucose, weight and blood pressure reduction, and improvements in lipid profile-translate into reduction of diabetes complications for Asian patients.”
Reference: Sheu WH, et al. Efficacy and tolerability of exenatide twice daily and exenatide once weekly in Asian versus white patients with type 2 diabetes mellitus: a pooled analysis. Diabetes Res Clin Pract. Epub 2016 Jan 9.