Monday, February 28, 2011


Over the weekend, I had to sit in a company ( in this case, Novo Nordisk ) cardiac advisory board meeting on their new drug, Liraglutide / Victoza, for the management of diabetes. As we all know Liraglutide, is a GLP-1 human analogue, meaning that although it is made from recombinant genes, it works like the human GLP ( Glucagon like peptide )hormone. With this new tool of recombinant genes, we can do that now with many products ( meaning that we can copy nature ).
I suppose, the current group of drugs coming into the market for management of diabetes, tries to mimick the body's natural feedback loop, in the sense that the drug only works when there is glucose to reduced. They are no longer secretogogues ( drugs that stimulate the pancreas to product more insulin ), but they are insulin sensitisers or insulin assist agents. This principle overcomes one of the biggest problem in diabetic management, and that is hypoglycemia. We now know that management of diabetes is often plague by the complication of hypoglycemia when one is using the older generation secretogogues. Basically, secretogogues are out, medically, but because they are very cheap ( when compared to the newer agents ), they are in commercially.
Anyway, this liraglutide looks like an interesting agent. I think the fact that it lowers blood sugar effectively is not in doubt. What I was concerned about, at the presentation, was the fact that there are extra blood sugar lowering effects. The human body is very complex and so not compartmentalised. Liraglutide also acts centrally to make one lose appetitie and also acts on the renal tubules to make one lose salt and water ( in that case, it also lowers blood pressures ). On the surface, that looks good. Now we have an agent ( given by injection, subcutaneously ) that can lower blood sugar ( for use in diabetes ), that can also make one lose weight ( maybe open to abuse by non diabetics ), and which may upset the body's fluid balance ( losing salt and water has other consequences ). Obviously, these pleotrophic effects of liraglutide, can be harness for good by doctors, but there is also a great potential for it to be abused, by others.
All things said and done, I think there is a role, but I did express my concern at the meeting, that it is an injectable ( and most patients here equate injectable to insulin ) and this is a drawback, and also the pricing? Is it going to be affordable, given that it may be lifelong therapy. I am also a little concerned, that since it also acts centrally ( at the brain level ), to reduce satiety ( appetite ), will it also have other CNS actions that may lead to depression and suicides, as we have seen with some other weight losing, appetite surpressing drugs. For which reason, I also express concern that long term data ( their longest is 2 years ), may be necessary for all of us, clinicians, to feel comfortable.
Basically a nice meeting. The drug looks promising, although there may be a few more questions to be answered.
It also gave me another occasion to use to LRT to get to Le Meridien, where the meeting was held. Always in support of efficient public transport.

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