Emerging GLP-1 receptor agonists

Introduction: Recently, glucagon-like peptide-1 receptor (GLP-1R) agonists have become available for the treatment of type 2 diabetes. These agents exploit the physiological effects of GLP-1, which is able to address several of the pathophysiological features of type 2 diabetes. GLP-1R agonists presently available are administered once or twice daily, but several once-weekly GLP-1R agonists are in late clinical development. Areas covered: The present review aims to give an overview of the clinical data on the currently available GLP-1R agonists used for treatment of type 2 diabetes, exenatide and liraglutide, as well as the emerging GLP-1R agonists including the long-acting compounds. Expert opinion: An emerging therapeutic trend toward initial or early combination therapy with metformin-and incretin-based therapy is anticipated for patients with type 2 diabetes. GLP-1-based therapy has so far proven safe and tolerable. The determination of which incretin-based therapy to choose necessitates comparisons between the various GLP-1R agonists. The available GLP-1R agonists cause sustained weight loss and clinical relevant improvement of glycemic control. The long-acting GLP-1R agonists in late development may improve the effects of GLP-1 even further with optimized pharmacokinetic profiles resulting in fewer side effects. Meta-analyses have shown promising effects on cardiovascular disease and data from ongoing multicenter trials with cardiovascular endpoints are expected in 2015.