New and Emerging Pharmacologic Therapies for Type 2 Diabetes, Dyslipidemia, and Obesity

• Published in: Clinical therapeutics 2013, Vol.35 (1), p.A3-A17
• Main Authors: Taylor, James R., PharmD, CDE, Dietrich, Eric, PharmD, BCPS, Powell, Jason G., PharmD
• Format: Article
• Language: English
• Subjects: Anti-Obesity Agents - adverse effects; Anti-Obesity Agents - economics; Anti-Obesity Agents - therapeutic use; canagliflozin; Cholesterol; Clinical trials; Cost-Benefit Analysis; dapagliflozin; Diabetes; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Drug Costs; Drug dosages; dyslipidemia; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - economics; exenatide extended-release; Gastrointestinal surgery; Glucose; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Hypolipidemic Agents - adverse effects; Hypolipidemic Agents - economics; Hypolipidemic Agents - therapeutic use; Icosapent ethyl; Internal Medicine; Medical Education; Mortality; Obesity; Obesity - diagnosis; Obesity - drug therapy; Obesity - economics; Patients; Studies; Treatment Outcome; Triglycerides; Weight control
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2012.12.012

Abstract Background Type 2 diabetes, dyslipidemia, and obesity continue to be common disorders that many clinicians and patients struggle to control. There are likely numerous reasons for poor control of these diseases, including medication efficacy and adverse effects, access to medications and health care, poor adherence, and lack of lifestyle changes by patients. Several new and emerging medications may help resolve these issues. Objective The goal of this article is to review new and emerging medications for type 2 diabetes mellitus, dyslipidemia, and obesity. Methods The Food and Drug Administration drug approval list for 2011 and 2012 was searched to identify newly approved drugs for type 2 diabetes, dyslipidemia, and obesity. New drug entities or existing drug entities with a new indication were included. To identify emerging therapies, we performed targeted searches on clinicaltrials.gov using the listed disease states and Phase III studies. PubMed was searched with these drug names to identify clinical trials for inclusion in this review. Preclinical trials and non–English-language publications were excluded, as were trials not evaluating the efficacy of these agents. The websites goodRx.com and rxpriceverify.com were used to identify pricing. Results For type 2 diabetes, exenatide extended-release causes fewer adverse effects and better efficacy than the daily exenatide formulation. The new sodium-glucose cotransporter 2 inhibitor drug class has a unique mechanism of action, hemoglobin A1c reductions near 1%, and seemingly few adverse effects. With respect to dyslipidemia, icosapent ethyl effectively lowers triglyceride levels by ∼20% to 45% (depending on baseline triglyceride level), with little effect on LDL-C. For treatment of obesity, lorcaserin is a novel anorexic agent that results in an ∼5.5-kg mean weight loss, and phentermine-topiramate controlled-release reduces weight by ∼12.2 kg. Conclusion Although these agents certainly add to our armamentarium, none appear to offer significant advantages over currently available options. High costs will likely prevent these novel agents from being used as first-line agents in most patients. Further studies will help to more clearly define their roles in therapy.