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Efficacy and Safety of the Human Glucagon-Like Peptide-1 Analog Liraglutide in Combination With Metformin and Thiazolidinedione in Patients With Type 2 Diabetes (LEAD-4 Met+TZD)

Zinman, Bernard, Gerich, John, Buse, John B., Lewin, Andrew, Schwartz, Sherwyn, Raskin, Philip, Hale, Paula M., Zdravkovic, Milan, Blonde, Lawrence
Diabetes care 2009 v.32 no.7 pp. 1224-1230
agonists, blood glucose, body mass index, c-peptide, fasting, gastrointestinal system, glucagon-like peptide 1, glucose, glycemic control, homeostasis, humans, hypoglycemia, metformin, noninsulin-dependent diabetes mellitus, patients, systolic blood pressure, therapeutics, weight gain, weight loss
OBJECTIVE: To determine the efficacy and safety of liraglutide (a glucagon-like peptide-1 receptor agonist) when added to metformin and rosiglitazone in type 2 diabetes. RESEARCH DESIGN AND METHODS: This 26-week, double-blind, placebo-controlled, parallel-group trial randomized 533 subjects (1:1:1) to once-daily liraglutide (1.2 or 1.8 mg) or liraglutide placebo in combination with metformin (1 g twice daily) and rosiglitazone (4 mg twice daily). Subjects had type 2 diabetes, A1C 7-11% (previous oral antidiabetes drug [OAD] monotherapy greater-than-or-equal3 months) or 7-10% (previous OAD combination therapy greater-than-or-equal3 months), and BMI [less-than or equal to]45 kg/m². RESULTS: Mean A1C values decreased significantly more in the liraglutide groups versus placebo (mean ± SE -1.5 ± 0.1% for both 1.2 and 1.8 mg liraglutide and -0.5 ± 0.1% for placebo). Fasting plasma glucose decreased by 40, 44, and 8 mg/dl for 1.2 and 1.8 mg and placebo, respectively, and 90-min postprandial glucose decreased by 47, 49, and 14 mg/dl, respectively (P < 0.001 for all liraglutide groups vs. placebo). Dose-dependent weight loss occurred with 1.2 and 1.8 mg liraglutide (1.0 ± 0.3 and 2.0 ± 0.3 kg, respectively) (P < 0.0001) compared with weight gain with placebo (0.6 ± 0.3 kg). Systolic blood pressure decreased by 6.7, 5.6, and 1.1 mmHg with 1.2 and 1.8 mg liraglutide and placebo, respectively. Significant increases in C-peptide and homeostasis model assessment of β-cell function and significant decreases in the proinsulin-to-insulin ratio occurred with liraglutide versus placebo. Minor hypoglycemia occurred more frequently with liraglutide, but there was no major hypoglycemia. Gastrointestinal adverse events were more common with liraglutide, but most occurred early and were transient. CONCLUSIONS: Liraglutide combined with metformin and a thiazolidinedione is a well-tolerated combination therapy for type 2 diabetes, providing significant improvements in glycemic control.