In some of my earlier posts, you can read about the association between diabetes and osteoarthritis risk. One of the common risk factors for both type II diabetes as well as osteoarthritis is obesity. Not only does obesity put added strain on one's joints, but it increases the risk of insulin resistance.
For patients that have both of these conditions, an important treatment option to discuss with your health care provider is the drug Byetta (Exenatide). It is a new diabetes treatment from Eli Lilly and Amylin that is extracted from the saliva of the Gila monster received approval from the Food and Drug Administration.
Unfortunately, many patients with type II diabetes will not like the route of administration for Byetta. However, I heard on the news just this morning that three pharmaceutical companies are developing a once a week type of dosing for the drug which they anticipate being available in 2008/9.
In terms of patients with both type II diabetes and osteoarthritis, one important side effect of Byetta is that it may actually cause weight loss. This is clearly beneficial to both conditions.
"Exenatide is the first in a new class of compounds, which possess similar activity to the naturally-occurring hormone glucagon-like peptide-1 (GLP-1). It mirrors many of the effects of GLP-1, improving glycaemic control through a combination of mechanisms, which include glucose-dependent stimulation of insulin secretion, suppression of glucagon secretion, slowing of gastric emptying and reduced appetite. Phase III clinical trials showed exenatide therapy for 30 weeks significantly reduced glycated haemoglobin, and fasting and postprandial plasma glucose compared with baseline when added to metformin and sulfonylureas or a combination of the two, with an average weight loss of approximately 2 kg.
Exenatide can also be used in combination with thiazolidinediones and may be an alternative to insulin in patients requiring additional therapy. In patients with established Type 2 diabetes, control of both glycaemia and body weight are important to minimise the risk of future diabetes complications. Open-label extensions from these pivotal trials demonstrate that patients treated with exenatide for 'less than or equal to' 3 years sustained the reductions in glycaemic control achieved at 30 weeks and had a progressive reduction in body weight. Exenatide is generally well tolerated; nausea is the most commonly reported side effect, but can be significantly reduced when a target dose of exenatide is achieved in patients with gradual dose titration.
Hypoglycaemia has been encountered in clinical trials of exenatide, especially on initiation of therapy with sulfonylureas (not with metformin). Exenatide may enable patients with Type 2 diabetes to improve glycaemic control and reduce or eliminate the risk of hypoglycaemia and weight gain."
Reference:
Barnett A. Exenatide. Expert Opin Pharmacother. 2007 Oct;8(15):2593-608.
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