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The Jury’s Still Out on Victoza for Diabetes

Novo Nordisk is well-known in the diabetes community for its insulins, Novolog and Levemir, used to treat mainly type 1 diabetes. But in the last year, Novo launched a new kind of injectable, a « first line of defense for people with type 2 diabetes » called Victoza (generic: liraglutide). It’s a glucagon-like peptide-1 (GLP-1) drug designed to stimulate insulin secretion when hyperglycemia (high blood sugar) is present.

Victoza is still the new kid on the block here in the US, having just been approved by the FDA on January 25. It was approved in Europe last July, and has already been used by a fair number of patients there.

The big question on the market, and among doctors and patients now is, how will Victoza stack up against Byetta, the most well-known injectable drug for type 2 diabetes? Byetta has been very successful as a weight-loss aid, but the nausea it causes makes it intolerable for some people.

One big difference is that Victoza has a longer half-life, so it can be injected just once a day, at any time. Byetta, by contrast, has to be taken at every meal.

How Well It Works

Through an online query, I was lucky to hear from Raymond, living with type 2 diabetes in England: « The doctor prescribed Victoza for me on the 6th of February and I have been taking 0.6mg per day at 8am. I have been able to reduce my insulin from 160 units per day to 100. »

The side effects, he says, were some nausea and stomach pains which lasted only about a week. « My appetite and hunger has been reduced and I seldom finish my evening meal. Most mornings I have to force myself to eat breakfast but I know I must keep a regular eating pattern. The Victoza I believe has really helped me as I was fast becoming insulin-intolerant. »

So what happens when patients combine Victoza with their usual oral anti-diabetes drugs? Funny you should ask. Diabetes Care recently published online the results of the LEAD-6 extension study, showing what happens when patients switched from Byetta to Victoza, in addition to the oral drugs. The data showed:

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• Mean A1C decreased from 7.2% to 6.9%

• A greater percentage of patients reached their A1C targets (42.5% vs. 57.9%)

• Patients also experienced further reductions in fasting plasma glucose, body weight, and systolic blood pressure

Potential Risks

OK, so Victoza received two thumbs up from both Raymond and Diabetes Care — but there are still some concerns. Victoza was given a Black Box warning: « Because of the uncertain relevance of the rodent thyroid C-cell tumor findings to humans, prescribe Victoza only to patients for whom the potential benefits are considered to outweigh the potential risk. » Although the marker for thyroid cancer present in patients was high, it was still within normal range, according to the authorities. Still, the only way to find out is to continue ongoing cancer monitoring for the next 15 years (!)

There have also been discussions that drugs like Byetta and Victoza can cause an increased risk of pancreatitis. In…

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