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2625 pages added, reviewed or updated during the last month (last updated: 15/4/2021)


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liraglutide in obesity

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Liraglutide is a glucagon like peptide-1 GLP-1) receptor agonist

  • Victoza (R) is a 1.8 mg daily subcutaneous injection of liraglutide that was initially approved by the FDA in 2010 as an adjunct therapy to diet and exercise for management of type 2 diabetes (1)
    • results from clinical trials repeatedly demonstrated the ability of GLP-1 analogs to induce weight loss - as a result, liraglutide was also developed as a weight loss agent and its 3.0 mg daily dose (Saxenda (R))
        • liraglutide 3 mg led to decreases in body weight of >5% to as much as 15% (2)

GLP-1 is a polypeptide incretin hormone secreted by the L-cells of the gastrointestinal tract in response to nutrients in the lumen.

  • GLP-1 causes (1):
      • a glucose dependent stimulation of insulin secretion
      • reduction in plasma glucagon concentrations
      • delayed gastric emptying
      • appetite suppression
      • and an increase in heart rate
    • appetite suppression and delayed gastric emptying are thought to be responsible for the weight lowering effects of GLP-1 (1)
  • a 5%-10% reduction in body weight in overweight and obese individuals improves several risk factors for cardiovascular disease (CVD), including elevated blood glucose, blood pressure, and plasma triglyceride concentrations

NICE have stated that (4):

  • Liraglutide is recommended as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults, only if:
    • they have a body mass index (BMI) of at least 35 kg/m2 (or at least 32.5 kg/m2 for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population) and

    • they have non-diabetic hyperglycaemia (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre) and

    • they have a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia and

    • it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service and

    • the company provides it according to the commercial arrangement.

Notes:

  • the dose of liraglutide for obesity (see summary of product characteristics for full details):
    • starting dose is 0.6 mg once daily. The dose should be increased to 3.0 mg once daily in increments of 0.6 mg with at least one week intervals to improve gastro-intestinal tolerability

Reference:

Last edited 12/2020 and last reviewed 12/2020

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