Exenatide

A pioneering GLP-1 RA with a long safety track record. Largely superseded by once-weekly agents with greater efficacy.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

Extensive clinical trial data supports glycemic efficacy. The EXSCEL cardiovascular outcomes trial showed non-inferiority but not superiority for MACE. Weight loss is modest (2–3 kg). The drug has the longest post-marketing surveillance of any GLP-1 RA.

• Longest post-marketing safety track record in GLP-1 class
• Available in twice-daily and once-weekly formulations
• Proven glycemic efficacy

Byetta: 5–10 mcg twice daily. Bydureon: 2 mg once weekly.

• Nausea
• Vomiting
• Injection-site nodules (Bydureon)
• Headache

Contraindicated in personal or family history of medullary thyroid carcinoma or MEN2. Not recommended in severe renal impairment. Injection-site nodules with extended-release formulation.

Largely been replaced by newer agents with better efficacy and dosing convenience. Cardiovascular superiority was not demonstrated.

• Weight loss40