A once weekly diabetes drug has been tested and shown to be non-inferior to a once daily drug in the same class of treatments. The once weekly DPP-4 inhibitor, trelagliptin, was shown to be non-inferior to the once daily DPP-4 inhibitor, alogliptin (which has the brand name Nesina).

DPP-4 inhibitors, also known as gliptins, are a tablet form of drug for treating type 2 diabetes. One of the key advantages that DPP-4 inhibitors have over some of the other drug classes, such as sulfonylureas, is that they do not promote weight gain. Currently, the gliptin drugs that are available are those that need to be taken daily.

The yet to be approved, once weekly trelagliptin was tested against the currently available, once daily alogliptin (Nesina) and also against placebo. In the study, 101 participants took trelagliptin, 92 took alogliptin and 50 took a placebo. To test for the effectiveness of the once weekly drug, relative to the once daily treatment and placebo, HbA1c was measured at the start of the study and at the end of the 24 week study period.

The results showed:

  • Alogliptin resulted in a 0.45% reduction in HbA1c relative to placebo
  • Trelagliptin resulted in a 0.33% reduction in HbA1c relative to placebo

The difference in change of HbA1c between alogliptin and trelagliptin was 0.11% which was within the non-inferiority margin of 0.4%. In terms of side effects, trelagliptin was well tolerated and the number of adverse events was similar to the once daily alogliptin. No episodes of hypoglycemia were recorded during the study period.

The fact that trelagliptin is once weekly could help to improve adherence to treatment by reducing the number of doses that can be forgotten. Whilst the study recorded a result of non-inferiority for the once weekly trelagliptin, the results indicated that it may not be quite as effective as the once daily DPP-4 inhibitor it was compared against. So the study asks a question of whether a smaller reduction in HbA1c is justified by the potential for greater adherence.

Other factors that will require consideration by patients and doctors will be the cost of the new treatment as well as whether any differences in side effects emerge in future clinical trials.

Trelagliptin and alogliptin (Nesina) have been developed and sold by Takeda Pharmaceutical Company. The study is published by The Lancet Diabetes and Endocrinology journal.