Beruflich Dokumente
Kultur Dokumente
Disclosure
Dr. Quiles Alves is a contracted speaker for
Merck & Sharp Co.
Dr. Melin has nothing to disclose
Learning Objectives
Review existing pharmacotherapy options for diabetes
mellitus and how they benefit the patient
Discuss new therapy options for the diabetes
Review existing pharmacotherapy options for weight
loss and determine which agents may be used safely
long-term
Discuss the data regarding the use of these agents in the
diabetic patient population
Diabetes Management
Updates on New Drugs: 2014
Farxiga (dapagliflozin)
Sodium glucose cotransporter type 2 (SGLT-2) inhibitor
o MOA: modulates reabsorption of glucose in the kidney, resulting in
glucose excretion in the urine
Jardiance (empagliflozacin)
SGLP-2 inhibitor
Indicated as adjuvant with diet and exercise
Recommended dose 10mg daily with or
without food
SE: urinary tract infections, mycotic
inections in female
Tanzeum (albiglutide)
MOA: is a GLP-1 receptor agonist
o
Trulicity (dulaglutide)
MOA: GLP-1 receptor agonist
o
o
Xigduo XR
(dapagliflozin +metformin HCL)
MOA: SGLT-2 + metformin ER
Adjunct Tx with diet and exercise to control
glycemic control when appropriate with each
medication
Oral tablet, 10/2,000mg recommended dose
once daily with food and titrate dose
SE: hypoglycemia, GIs symptoms
Weight Loss
Pharmacotherapy
2014 Update
Pharmacologic Classes
Pharmacologic strategies for weight reduction
Noradrenergic agents
GI lipase inhibition
Serotonin receptor agonists
Combination therapy
ONLY used as adjunct to comprehensive
lifestyle intervention
Noradrenergic agents
For short-term use only (12 weeks)
o
Phentermine
Diethylpropion
Phendimetrazine
Benzphetamine
GI lipase inhibition
Orlistat
o
o
o
o
o
Combination therapy
Phentermine/Topiramate extended release
(Qsymia)
Requires titration to target doses
REMS program
o
Combination therapy
Naltrexone/Bupropion extended release
(Contrave)
Requires titration to target doses
D/C if 5% decrease in weight not achieved
after 12 weeks at maintenance dosage
Pt should be opioid free for minimum of 7-10
days (14 days for buprenorphine/methadone)
Weight Loss in DM
Orlistat: XENDOS
o
Lorcaserin: BLOOM-DM
o
o
Herbal Supplements
Look out!
o
References
Zoungas S, Chalmers J, Neal B, et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med 2014; 371:1392.
Weissman PN, Carr MC, Ye J, et al. HARMONY 4: randomised clinical trial comparing once-weekly albiglutide and insulin glargine in patients with type 2 diabetes inadequately
controlled with metformin with or without sulfonylurea. Diabetologia 2014.
http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002735/human_med_001735.jsp&mid=WC0b01ac058001d124 (Accessed on April 16, 2014).
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm393289.htm (Accessed on April 17, 2014).
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415180.htm (Accessed on September 19, 2014).
http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002825/smops/Positive/human_smop_000729.jsp&mid=WC0b01ac058001d127 (Accessed on
October 15, 2014).
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm403122.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Accessed on June 30,
2014).
Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014; 370:1514.
FDA adding general warning to testosterone products about potential for venous blood clots. US Food and Drug Administration (FDA) Drug Safety and Availability. Last updated
June 25, 2014. (Available online at http://www.fda.gov/Drugs/DrugSafety/ucm401746.htm (accessed June 30, 2014)).
http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails (Accessed on June 03, 2014).
http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm413896.htm.
References
Yanovski SZ, Yanovsk JA. Long-term drug treatment for obesity: A systematic and clinical review. JAMA 2014;311(1):74-86.
Torgerson JS, Hauptman J, Boldrin MN, Sjstrm L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of
orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27(1):155-161.
Smith SR,Weissman NJ, Anderson CM, et al; Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM) Study
Group. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med 2010;363(3):245-256.
Fidler MC, Sanchez M, Raether B, et al; BLOSSOM Clinical Trial Group. A one-year randomized trial of lorcaserin for weight loss in obese and
overweight adults: the BLOSSOM trial. J Clin Endocrinol Metab 2011;96(10):3067-3077.
ONeil PM, Smith SR,Weissman NJ, et al. Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the
BLOOM-DM study. Obesity (Silver Spring) 2012;20(7):1426-1436.
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated
comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet 2011;377(9774):1341-1352.
Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese
and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr 2012;95(2):297-308.
Caixs A, Albert L, Capel I, Rigla M. Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to
date. Drug Design, Development and Therapy 2014:8 14191427.