Place in therapy for liraglutide and saxagliptin for type 2 diabetes.

BACKGROUND: The release of incretin based therapeutic entities has brought the possibility to offer control of the disease by augmenting a natural process in the body that has become deficient with type 2 diabetes. Liraglutide, an incretin mimetic, and saxagliptin, a dipeptidyl peptidase-4 inhibitor, have been approved and introduced to the market. OBJECTIVES: To (a) review the efficacy and safety data of for the treatment of type 2 diabetes, and (b) recommend their place in therapy. METHODS: A MEDLINE search was performed using key words "liraglutide" and "saxagliptin" for articles published and available through July 2010. RESULTS: The Liraglutide Effect and Action in Diabetes (LEAD) trials encompassed six published phase 3 trials that evaluated the efficacy and safety of liraglutide either as monotherapy or in addition to oral hypoglycemic medications. Saxagliptin has been studied as monotherapy and in combination to oral hypoglycemic medications. CONCLUSIONS: Liraglutide has been shown to improve glucose control and weight loss compared to other pharmacologic treatments with diabetes and may offer improved control with a decrease in daily dosing compared to exenatide. Saxagliptin improved glucose control as monotherapy or in combination with medications other than sulfonylurea. Saxagliptin has not been evaluated head to head with sitagliptin other than in combination with metformin where saxagliptin was deemed noninferior. Given the lack of long-term safety and clinical data compared to current treatment modalities, and more importantly the overall cost of the therapies to the health care system, a global recommendation for their use cannot be issued.