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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.
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.
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."