Monograph

3. Honest Drug Reviews Spotlight on New T2DM Agents!

As a disclaimer, this is definitely not an exhaustive review of each drug; in which case, you should definitely consult the product monograph if you want to learn more!

Coming to a pharmacy near you are some nifty agents that provide alternative ways to manage Type 2 diabetes mellitus. Eperzan, Jardiance and Trulicity were all approved by Health Canada within the past year. As such, it seems only fitting to evaluate the impact these drugs may have by presenting some interesting highlights and features of each...with some added comic relief!


EPERZAN
Our first agent, Eperzan, is brought to you by GlaxoSmithKline Inc. Judging by its generic name "albiglutide" you could probably guess how this drug works. And you're thinking, "well duh, it must be a GLP-1 agonist!". Similar to exenatide (Byetta) and liraglutide (Victoza), it acts on the GLP-1 receptors found in your pancreas to increase the production of insulin. So now you're probably thinking, if this drug works similar to exenatide and liraglutide, what's the big deal? Well, that would be its half-life! Albiglutide has a very long half-life (~5 days), compared to Byetta and Victoza which are much shorter, 2.5 hours and 11-14 hours, respectively. Thus, an advantage of albiglutide is its once-weekly dosing compared to exenatide (bid dosing) and liraglutide (daily dosing). However, keep in mind, exenatide is available in an extended-release formulation allowing for weekly dosing under the brand name, Bydureon; in addition, another GLP-1 agonist (that will be discussed later) also allows for once-weekly dosing...so maybe it's not that special after all...

Eperzan is available in 30mg/0.5mL or 50mg/0.5mL prefilled syringes. You can expect the typical dose to be 30mg subcutaneously every week. What I consider a huge disadvantage to this product is how inconvenient it is to use. The pen has two compartments to separate the medicated powder from the solvent before use. The patient "twists" the pen to mix the medication, but then has to wait 15 minutes for the medicine to dissolve before it can be used. Considering patients don't like waiting 15 minutes for their medications at the pharmacy, I doubt they'll be game to wait 15 minutes until they can actually use their medication.

In terms of safety, the most common reported side effects (>10%) include diarrhea, nausea (because which drug doesn't have these side effects?) and, not surprisingly, injection site reactions (rash, erythema, itchiness). Interestingly, a concern identified is the development of thyroid C cell tumours in animal studies. This effect has not conclusively been demonstrated in humans; however, Eperazan is a "hell nah!" (i.e. a contraindication) in patients with a personal or family history of medullary thyroid carcinoma (MTC).

In summary, Eperzan is like that guy or girl you met on OKCupid - seemed great, but ended up being too high-maintenance.



JARDIANCE
From the people that brought you Trajenta, comes another T2DM drug for you to memorize for your PHM202 Small Group Seminar! Jardiance (empagliflozin) was developed by Boeringher Ingelheim (with what appears to be some involvement with Eli Lilly).

"---flozin" ...where have I heard that before? Invokana (canagliflozin)...Forxiga (dapagliflozin)...yup, Jardiance is an SGLT2 inhibitor! From what I gathered, Jardiance does not boast any startling features to set it apart from the other SGLT2 inhibitors. It is available in 10mg or 25mg oral tablets, and allows for the same convenient once daily dosing. In addition, the expected side effects are noted, dehydration (leading to subsequent hypotension), urinary tract infections, and genital fungal infections, to name a few.



TRULICITY
Probably the prettiest name I've ever heard for a drug. It's generic name "dulaglutide" may prompt you to think, "wait a minute...another GLP-1 agonist?" Yes, indeed. Consider it Eli Lilly's answer to GSK's Eperzan. With a half-life of 4.7 days, Trulicity is also a once-weekly injection, available in strengths 0.75mg/mL and 1.5mg/mL. A definite plus with this medication is its easy-to-use pen. Each pen is a single dose, and is very patient-friendly in terms of administration. Honestly, compare the "how-to-use" video of Trulicity with that of Victoza and you'll see what I mean. The patient simply uncaps the device, places the device on the instructed area of the body, then turns the dial to unlock the device, and then presses and holds the button for 5-10 seconds to deliver the medication. In terms of ease of use, Trulicity definitely beats out Eperzan. Trulicity's side effect profile also mirrors that of Eperzan. I'd say, for the time being, Trulicity appears to be the real game-changer among the GLP-1 agonists!

Credits (In Order of Appearance):

-Health Canada. (2016, Feb 2). Eperzan. Health Canada: Drugs and Health Products. Retrieved from: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2015_eperzan_165145-eng.php.
-GlaxoSmithKline UK. Package leaflet: Information for the patient. Retrieved from: https://www.medicines.org.uk/emc/PIL.31393.latest.pdf
-Health Canada. (2016, Jul 29). Jardiance. Health Canada: Drugs and Health Products. Retrieved from: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2015_jardiance_162552-eng.php. Nauk, M. (2014). Updates on developments with SGLT2 inhibitors in the management of type 2 diabetes. Drug Des Devel Ther. 2014; 8: 1335-1380.
-Health Canada. (2016, May 11). Trulicity. Health Canada: Drugs and Health Products. Retrieved from: http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd-smd-2016-trulicity-168671-eng.php
-Eli Lilly. (2016). How to use Trulicity pen. Retrieved from: https://www.trulicity.com/taking-diabetes-medicine.html.
-Novo Nordisk. (2016). Your first Victoza injection. Retrieved from: https://www.victoza.com/get-started-using-victoza-/your-first-injection.html.