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Comparison of liraglutide versus other incretin‐related anti‐hyperglycaemic agents

The two classes of incretin‐related therapies, dipeptidyl peptidase‐4 (DPP‐4) inhibitors and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), have become important treatment options for patients with type 2 diabetes. Sitagliptin, saxagliptin, vildagliptin and linagliptin, the available DPP‐4 inhibitors, are oral medications, whereas the GLP‐1 RAs—twice‐daily exenatide, once‐weekly exenatide and once‐daily liraglutide—are administered subcutaneously. By influencing levels of GLP‐1 receptor stimulation, these medications lower plasma glucose levels in a glucose‐dependent manner with low risk of hypoglycaemia, affecting postprandial plasma glucose more than most other anti‐hyperglycaemic medications. Use of GLP‐1 RAs has been shown to result in greater glycaemic improvements than DPP‐4 inhibitors, probably because of higher levels of GLP‐1 receptor activation. GLP‐1 RAs can also produce significant weight loss and may reduce blood pressure and have beneficial effects on other cardiovascular risk factors. Although both classes are well tolerated, DPP‐4 inhibitors may be associated with infections and headaches, whereas GLP‐1 RAs are often associated with gastrointestinal disorders, primarily nausea. Pancreatitis has been reported with both DPP‐4 inhibitors and GLP‐1 RAs, but a causal relationship between use of incretin‐based therapies and pancreatitis has not been established. In clinical trials, liraglutide has shown efficacy and tolerability and resulted in certain significant benefits when compared with exenatide and sitagliptin.