Both Liraglutide and Sitagliptin play significant roles in control of diabetes

In the European Association for the Study of Diabetes (EASD) 2010 Meeting, the results of LEAD (Liraglutide Effect and Action in Diabetes) series of trials were discussed.

Liraglutide, a glucagonlike peptide-1 (GLP-1) agonist and another incretin, the oral agent sitagliptin —a dipeptidyl-peptidase-4 (DPP-4) inhibitor were compared.

The results show that liraglutide is generally well tolerated and reduces glycated hemoglobin levels (HbA_1c) and body weight to a greater extent than sitagliptin when added to metformin treatment.
 The authors specified that the patients on the higher dose of liraglutide reported greater overall patient satisfaction.
Discussant of the session, Dr Jonathan Bodansky (St James University Hospital, Leeds, UK), said both agents were useful additions to the diabetologists' armamentarium, with the decision about therapy coming down to physician and patient choice.
Bodansky agreed the data so far do indicate that liraglutide results in more weight loss than sitagliptin, but "they both go in the right direction," and it is "gratifying" to see weight loss with sitagliptin, he said, which has previously been considered "weight neutral." "This is the first oral drug for glycemia that also has weight loss," he commented.
It was also stressed that the fact that liraglutide induces greater weight loss than sitagliptin has to be balanced against the fact that it is an injectable agent with a high rate of nausea as a side effect.
 It was highlighted that as both liraglutide and sitagliptin showed a fall in glycemia and body weight, so now the patient has a treatment choice. The ideal treatment for type 2 diabetes should improve glycemia and induce progressive weight loss.
This compares with what was on offer from older drug classes, such as sulfonylureas and glitazones, which induce weight gain. Sitagliptin and liraglutide are effective when added to metformin and may become, in time, first-line treatment in the future."
In fact, Bodansky says these newer agents may also allow a cautious reduction in dose of insulin or even withdrawal in some insulin-dependent diabetics. In patients who are overweight with poor diabetes control, a very cautious reduction or withdrawal of insulin while transferring onto newer therapy has been successful in some of our patients.
A 26- week study involving both the drugs was publishedd early this year.(2)
(1) http://www.theheart.org/article/1126861.do
(2) Pratley RE, Nauck M, Bailey T, et al. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycemic control with metformin: a 26-week, randomized, parallel-group, open-label trial. Lancet 2010; 375:1447-1456.