BYETTA delivered significant improvements in beta-cell function at 1 and 3 years

By the time of disease diagnosis, up to 80% of beta-cell function may be lost.¹ Beta-cell dysfunction and impaired incretin response are defects that contribute to hyperglycemia and drive disease progression.^2,3 BYETTA delivered improvements in beta-cell function at 1 year and 3 years through restoration of first-phase insulin response.^4,5

During BYETTA treatment, improved beta-cell response was seen in metformin-treated patients (N = 69) in a comparator-controlled clinical trial after 1 year⁴

As demonstrated by the hyperglycemic clamp, 52 weeks of BYETTA therapy improved 3 key measures of insulin secretion compared to baseline:

• First-phase insulin response was increased 1.78-fold.
• Second-phase insulin response was increased 3.05-fold.
• Maximum insulin secretion was increased 3.19-fold as measured by arginine-stimulated C-peptide secretion.

C-peptide concentrations returned to baseline levels 4 weeks after treatment was discontinued.

After 3 years in an open-label extension trial, BYETTA patients continued to see improvements in acute beta-cell response⁵

Improvement in a key measure of beta-cell function compared to pretreatment was seen with BYETTA after 3 years.

• Disposition index (a measure of first-phase glucose-stimulated C-peptide secretion adjusted for insulin-stimulated whole-body glucose uptake) was significantly improved with BYETTA (n = 16) compared to pretreatment levels (+1.43 ± 0.78).

Indication and Usage

BYETTA is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

• Not a substitute for insulin and should not be used in patients with type 1 diabetes or diabetic ketoacidosis.
• Concurrent use with prandial insulin cannot be recommended.
• Has not been studied in patients with a history of pancreatitis. It is unknown whether patients with a history of pancreatitis are at increased risk for pancreatitis while using BYETTA; consider other antidiabetic therapies for these patients.

Important Safety Information for BYETTA^® (exenatide) injection

Contraindications

• BYETTA is contraindicated in patients with prior severe hypersensitivity reactions to exenatide or to any of the product components.

Warnings and Precautions

• Based on postmarketing data BYETTA has been associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. After initiation and dose increases of BYETTA, observe patients carefully for pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting). If pancreatitis is suspected, BYETTA should be discontinued promptly. BYETTA should not be restarted if pancreatitis is confirmed.
• Increased risk of hypoglycemia when used in combination with glucose-independent insulin secretagogues (eg, sulfonylureas); reduction of the sulfonylurea dose may be needed. When used with insulin, evaluate and consider reducing the insulin dose in patients at increased risk of hypoglycemia.
• Postmarketing reports of altered renal function, including increased serum creatinine, renal impairment, worsened chronic renal failure, and acute renal failure, sometimes requiring hemodialysis and kidney transplantation. BYETTA should not be used in patients with severe renal impairment or end-stage renal disease. Use with caution in patients with renal transplantation or when initiating or escalating the dose in patients with moderate renal failure.
• Not recommended in patients with severe gastrointestinal disease (eg, gastroparesis).
• Patients may develop antibodies to exenatide. In 3 registration trials, antibody levels were measured in 90% of patients, with up to 4% of patients having high-titer antibodies and attenuated glycemic response. If worsening of or failure to achieve adequate glycemic control occurs, consider alternative antidiabetic therapy.
• Postmarketing reports of serious hypersensitivity reactions (eg, anaphylaxis and angioedema). If this occurs, patients should discontinue BYETTA and other suspect medications and promptly seek medical advice.
• No clinical studies establishing conclusive evidence of macrovascular risk reduction with BYETTA or any other antidiabetic drug.

Adverse Reactions

• Most common adverse reactions in registration trials associated with BYETTA vs placebo (PBO): nausea (44% vs 18%), vomiting (13% vs 4%), and diarrhea (13% vs 6%). Other adverse reactions ≥5% and more than PBO: feeling jittery, dizziness, headache, and dyspepsia. With a thiazolidinedione (TZD), adverse reactions were similar; as monotherapy, most common was nausea (8% vs 0%). With insulin glargine: nausea (41% vs 8%), vomiting (18% vs 4%), diarrhea (18% vs 8%), headache (14% vs 4%), constipation (10% vs 2%), dyspepsia (7% vs 2%), asthenia (5% vs 1%).
• Hypoglycemia incidence, BYETTA vs PBO, with metformin (MET): 5.3% (10 mcg) and 4.5% (5 mcg) vs 5.3%; with SFU, 35.7% (10 mcg) and 14.4% (5 mcg) vs 3.3%; with MET + SFU, 27.8% (10 mcg) and 19.2% (5 mcg) vs 12.6%; with TZD, 10.7% (10 mcg) vs 7.1%; as monotherapy, 3.8% (10 mcg) and 5.2% (5 mcg) vs 1.3%; with insulin glargine, 24.8% (10 mcg) vs 29.5%.
• Withdrawals: as monotherapy, 2 of 155 BYETTA patients withdrew due to headache and nausea vs 0 PBO; with MET and/or SFU vs PBO, nausea (3% vs <1%) and vomiting (1% vs 0); with TZD ± MET, nausea (9%) and vomiting (5%), with <1% of PBO patients withdrawing due to nausea; with insulin glargine vs PBO, nausea (5.1% vs 0), vomiting (2.9% vs 0).

Drug Interactions

• BYETTA slows gastric emptying and can reduce the extent and rate of absorption of orally administered drugs. Use with caution with medications that have a narrow therapeutic index or require rapid gastrointestinal absorption. Medications dependent on threshold concentrations for efficacy should be taken at least 1 hour before BYETTA.
• Postmarketing reports of increased international normalized ratio (INR) sometimes associated with bleeding with concomitant use of warfarin. Monitor INR frequently until stable upon initiation or alteration of BYETTA.

Use in Specific Populations

• Based on animal data, BYETTA may cause fetal harm and should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
• Caution should be exercised when administered to a nursing woman.
• Safety and effectiveness have not been established in pediatric patients.

For complete safety profile and other important prescribing considerations, see the Prescribing Information and Medication Guide.

References

1. DeFronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795.
2. Ferrannini, E Gastaldelli A, Miyazaki Y, et al. Beta-cell function in subjects spanning the range from normal glucose tolerance to overt diabetes: a new analysis. J Clin Endocrinol Metab. 2005;90(1):493-500.
3. Nauck M, Stockman F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986;29(1):46-52.
4. Bunck MC, Diamant M, Corner A, et al. One-year treatment with exenatide improves B-cell function, compared with insulin glargine, in metformin-treated type 2 diabetic patients: a randomized, controlled trial. Diabetes Care. 2009;32(5):762-768.
5. Bunck MC, Corner A, Eliasson B, et al. Extended, 3-year, exenatide therapy shows sustainable effects on beta cell disposition index in metformin treated patients with type 2 diabetes. Diabetologia. 2010;53(suppl 1):S338.