Lixisenatide

Lixisenatide Brand Name– ADLYXIN

What is Lixisenatide

Lixisenatide is a synthetic glucagon-like peptide-1 receptor agonist (GLP-1 RA) and belongs to a class of antidiabetic agents called incretin mimetics.

Incretins are endogenous compounds, including glucagon-like peptide-1 (GLP-1), that improve glycemic control once released into the circulation via the gut. Lixisenatide subcutaneous injection is used once daily as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (DM).

Several clinical trials have demonstrated the effectiveness of lixisenatide as monotherapy or in combination with oral antidiabetic medications +/- basal insulin.

Lixisenatide use results in statistically significant improvements in A1C and fasting plasma glucose.

In the treatment of type 2 DM, metformin is first-line. Additional therapy with a GLP-1 RA that has proven cardiovascular (CV) benefit should be considered in patients with indicators of high-risk or established CV disease, independent of baseline A1C or individualized A1C target.

There is no evidence of CV benefit with lixisenatide; however, in clinical trials, lixisenatide did not increase the risk of CV adverse events.

Among the GLP-1 RAs, evidence of CV benefit is strongest for liraglutide, favorable for semaglutide, and less certain for exenatide. GLP-1 RAs have high glucose-lowering efficacy, but with variation within the drug class.

Evidence suggests that the effect may be greatest for semaglutide once weekly, followed by dulaglutide and liraglutide, closely followed by exenatide once weekly, and then exenatide twice daily and lixisenatide. GLP-1 RAs improve CV outcomes, as well as secondary outcomes such as heart failure (HF) and progression of renal disease, in patients with established CV disease or chronic kidney disease (CKD); this makes them an alternative treatment option in patients with indicators of high-risk or established heart failure HF or CKD who cannot tolerate a sodium-glucose cotransporter 2 inhibitor (SGLT2i).

For patients requiring an injectable medication, GLP-1 RAs are preferred to insulin due to similar or even better efficacy in A1C reduction, lower risk of hypoglycemia, and reductions in body weight.

Indications

  • type 2 diabetes mellitus

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. antibody formation
  4. bronchospasm
  5. constipation
  6. diarrhea
  7. dizziness
  8. dyspepsia
  9. headache
  10. hypoglycemia
  11. hypotension
  12. injection site reaction
  13. laryngeal edema
  14. nausea
  15. pancreatitis
  16. pruritus
  17. renal failure (unspecified)
  18. urticaria
  19. vomiting

Monitoring Parameters

  • blood glucose
  • glycosylated hemoglobin A1c (HbA1c)
  • serum creatinine

Contraindications

  • alcoholism
  • angioedema
  • breast-feeding
  • children
  • cholelithiasis
  • diabetic ketoacidosis
  • gastroparesis
  • geriatric
  • history of angioedema
  • hypoglycemia
  • pancreatitis
  • pregnancy
  • renal failure
  • renal impairment
  • serious hypersensitivity reactions or anaphylaxis
  • type 1 diabetes mellitus

Interactions

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