Oleh Admin Kalbe Medical pada June 16, 2017 07:30

Exenatide Efektif sebagai Terapi DM tipe 2 yang Tidak Terkontrol dengan Metformin Monoterapi

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) merupakan salah satu kelas obat penurun glukosa darah untuk pasien DM tipe 2. Pemberian GLP-1 RA merupakan salah satu pendekatan terapi DM berupa injeksi yang direkomendasikan bagi pasien yang tidak terkontrol baik hanya dengan monoterapi metformin. Exenatide merupakan salah satu obat di golongan GLP-1 RA yang telah disetujui pemasarannya sebagai terapi DM tipe 2, dan telah tersedia dalam 2 formulasi, yaitu cairan untuk injeksi dua kali sehari dengan kekuatan 5 atau 10 μg (exenatide dua kali sehari/ BID) dan injeksi exenatide 2 mg lepas lambat seminggu sekali (exenatide QW). Formulasi kerja panjang ini mengandung komponen aktif exenatide original BID yang dipecah menjadi mikrosphere dari medical-grade poly-(d,l-lactide-co-glycolide) dalam formulasi cair. Exenatide QW ini menjadi GLP-1 RA pertama yang disetujui pemberiannya seminggu sekali.

Suatu studi dengan desain network meta-analisis dilakukan dalam rangka membandingkan efikasi klinis relatif dan tolerabilitas exenatide QW dengan GLP-1 RA lainnya yang disetujui di AS atau Eropa sebagai terapi DM tipe 2 yang gagal monoterapi metformin. Efikasi yang dinilai di antaranya adalah HbA1c, berat badan/BB, tekanan darah diastolik/TDS, dan proporsi pasien yang mencapai target glikemik (HbA1c <7% dan <7%) pada 24 ± 6 minggu. Tolerabilitas dinilai berdasarkan perhitungan relative odds dari efek samping mual atau penghentian terapi akibat kejadian tidak diinginkan lainnya.

Dengan menggunakan metode review sistematik, diidentifikasi 14 studi klinik acak terkontrol. Pemberian exenatide QW memberikan penurunan HbA1c yang signifikan secara statistik terhadap lixisenatide 20 μg sekali sehari. Tidak ditemukan adanya perbedaan yang signifikan pada penurunan HbA1c antara exenatide QW dan GLP-1 RA lainnya. Untuk perubahan pada BB, TDS, risiko mual, atau penghentian terapi akibat kejadian tidak diinginkan, tidak ditemukan perbedaan yang signifikan yang teramati baik dengan exenatide QW maupun GLP-1 RA lainnya.

Image : Ilustrasi
Referensi:
Kayaniyil S, Lozano-Ortega G, Bennett HA, Johnsson K, Shaunik A, Grandy S, et al. A network meta-analysis comparing exenatide once weekly with other GLP-1 receptor agonists for the treatment of type 2 diabetes mellitus. Diabetes Ther. 2016;7:27–43.
DOI 10.1007/s13300-016-0155-1.

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