AstraZeneca announced the publication of the 3-year results from DURATION-3, an open-label, randomized clinical trial comparing once-weekly exenatide with insulin glargine as first injectable therapy, in The Lancet Diabetes & Endocrinology. Once-weekly exenatide is a GLP-1 receptor agonist that is not currently approved as first-line therapy.

DURATION-3 enrolled patients with type 2 diabetes aged >18 years across 72 sites worldwide. Patients (n=456) were randomized 1:1 to once-weekly exenatide (2mg SC injection) or once-daily insulin glargine (via titration) to be added to their existing oral glucose-lowering regimens. The primary efficacy endpoint at 3 years was the change in HbA1c from baseline in patients given >1 dose of the assigned drug.

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At 3 years, least-squares mean HbA1c change was -1.01% in the exenatide group vs. -0.81% in the glargine group (least-squares mean difference -0.20%; 95% CI -0.39 to -0.02; P=0.03). Further, the exposure-adjusted rate of overall hypoglycemia was 3 times higher in patients given insulin glargine (0.9 events/patient/year) than in those given exenatide (0.3 events/patient/year).

Study authors were able to conclude that the once-weekly exenatide demonstrated sustained efficacy for 3 years. GLP-1 receptor agonists may be a possible long-term injectable treatment for patients with type 2 diabetes who have not started an insulin regimen.

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