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Comparing Diabetes Drugs: Januvia vs. Victoza

Study Shows Patients Get Better Control of Blood Sugar With Victoza

By Salynn Boyles
WebMD Health News

Reviewed By Laura J. Martin, MD

April 22, 2010 -- Type 2 diabetes patients who took the new once-a-day injectable drug Victoza achieved better blood sugar control and lost more weight than patients who took the widely prescribed oral drug Januvia, a study shows.

The trial is the first to compare two classes of diabetes drugs that target insulin-regulating hormones in the gut known as incretins, researchers say.

Incretin-based drugs are most often prescribed to patients who do not achieve target blood sugar levels with the drug metformin or other oral agents for diabetes.

Introduced early this year, Victoza is one of two FDA-approved drugs that mimic the activity of the naturally occurring incretin hormone GLP-1. The other is the twice-daily injected drug Byetta.

Januvia works by blocking DDP-4, a key enzyme that breaks down GLP-1.

Both classes of drugs increase insulin secretion and decrease secretion of the hormone glucagon, which raises blood sugar.

Comparison Study

In the new study, published April 24 in TheLancet, 665 type 2 diabetes patients who failed to achieve target blood sugar levels with metformin alone were treated with either once-daily injections of Victoza, at doses of 1.2 milligrams or 1.8 milligrams, or 100 milligrams of Januvia, taken by mouth once a day.

Over 26 weeks of treatment, patients on the highest dosage of the injected drug achieved the best blood sugar control and the most weight loss.

A main focus of the study was how well the two drugs lowered A1c, which measures blood sugar control over time.

Nearly twice as many patients taking Victoza reached a target A1c level of less than 7%, according to study researcher Richard Pratley, MD, of the University of Vermont College of Medicine.

The study was funded by Victoza manufacturer Novo Nordisk, which also participated in the study design, data collection, and data analysis. Pratley also acknowledged receiving consulting fees from both Novo Nordisk and Merck & Co., which makes Januvia.

While some patients in all three treatment groups lost weight, the overall weight loss was about 5 pounds more in those treated with the higher dose of Victoza than in those treated with Januvia, Pratley says.

Over 26 weeks, patients treated with 1.8 milligrams of Victoza lost, on average, 7 1/2 pounds, compared to 2 pounds with Januvia.

But the Victoza-treated patients also experienced more nausea, with 27% and 21%, respectively, in the 1.8-milligram and 1.2-milligram groups reporting the side effect, compared to 5% of those who took Januvia.

Assessing Treatment Options

Pratley says the study makes a clear case for the superiority of Victoza in patients who need aggressive blood sugar lowering and desire weight loss.

"But that doesn't mean it is necessarily the best option for everybody," he says. "Some patients don't need as much glucose lowering as others and some prefer an oral medication."

Merck spokesman Lee Davies tells WebMD that many patients prefer Januvia because it is taken by mouth and is less likely to cause nausea than the GLP-1-targeting therapies.

He points out that more than 21 million prescriptions for the oral drug have been written in the U.S. alone since it was approved three and one-half years ago.

"There is a history of experience with Januvia that has not yet been demonstrated with Victoza, which was just approved," he says.

Diabetes specialist Richard M. Bergenstal, MD, agrees that no single drug is best for all patients. He says patients who need more than metformin alone now have many options.

Bergenstal is executive director of the International Diabetes Center-Park Nicollet in Minneapolis and is president of medicine and science for the American Diabetes Association.

He says both Victoza and Januvia are good options for patients concerned about weight gain or low blood sugar, which are common side effects with older diabetes drugs like sulfonylureas.

But insulin and sulfonylurea may be better options for patients whose main concern is cost because they are much cheaper than the incretin-based therapies, he says.

"All the diabetes drugs have their pros and cons, and certainly no single drug is the best choice for every patient," he adds.

SOURCES:

Pratley, R. The Lancet, April 24, 2010.

Richard E. Pratley, MD, Diabetes and Metabolism Translational Medicine Unit, University of Vermont College of Medicine, Burlington, Vt.

Lee A. Davies, director, global media resources, Merck & Co.

Richard M. Bergenstal, MD, president of medicine and science, American Diabetes Association.

News release, The Lancet.

News release, Novo Nordisk.

© 2010 WebMD, LLC. All rights reserved.



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