whs pr symposium - pharmacotherapy for diabetes and weight management

8/10/2019 WHS PR Symposium - Pharmacotherapy for Diabetes and Weight Management

1/26

Pharmacotherapy for

Diabetes and WeightManagement: Update 20

Nicole M. Quiles Alves PharmD,M.P.H., RPhAssistant Professor of PharmacyPractice

Kyle Melin, PharmDAssistant Professor oPractice

"niversity of Puerto Rico School of Pharmacy


2/26

Disclosure

Dr. uiles !l"es is a contracted spea#Merc# $ %harp &o.

Dr. Melin has nothing to disclose


3/26

'earning (b)ecti"es

*e"ie+ e,isting pharmacotherapy options for dmellitus and ho+ they benefit the patient

Discuss ne+ therapy options for the diabetes

*e"ie+ e,isting pharmacotherapy options for +

loss and determine +hich agents may be used slong-term

Discuss the data regarding the use of these agendiabetic patient population


4/26

Diabetes Management"#$ates on Ne% Dru&s' ()*+


5/26


6/26


7/26


8/26


9/26

Updates 2014: e+ Drug

!bre//a insulin human inhalation po rapid inhale insulino use in adult patients for glycemic controlo M(!: stimulates peripheral glucose upta#e

s#eletal muscle and fatso ot a substitute for long-acting insulino Must be used in combination +ith long-acti

insulin in diabetes type 1 patientso %: hypoglycemia3 cough3throat pain3 irritat


10/26

ar,iga dapagliflo/in

%odium glucose cotransporter type 2 %5'6-2 o M(!: modulates reabsorption of glucose in the #idney3 resglucose excretion in the urine

7ndicated as ad)unct to diet and e,erciseo (ral administration3 starting dose 8mg

ot to use +ith e5* 9 0ml;min 6a#e !M +ith or +ithout food %: female genital mycotic infections3 urinary t

infections3 nasopharingitis


11/26


12/26

6an/eum albiglutide

M(!: is a 5'P-1 receptor agonisto !ugments glucose-dependant insulin secret

slo+s gastric emptying

7ndicated as an ad)unct to diet and e,

to impro"e glycemic control in DM 6y % in)ection - =0mg +ee#ly %: Upper respiratory tract infection3

diarrhea3 nausea3 in)ection site reactio


13/26

6rulicity dulaglutide

M(!: 5'P-1 receptor agonisto 7ncreases intracellular cyclic !MP c!MPin

cells leading to glucose-dependant insulin ro Decrease glucagon secretion and slo+s gastr

emptying

% in)ection3 initiating dose 0.>8mg + %: nausea3 diarrhea3 "omiting3 abdom

pain


14/26

?igduo ?*dapagliflo/in @metformin A&'

M(!: %5'6-2 @ metformin * !d)unct 6, +ith diet and e,ercise to cglycemic control +hen appropriate +imedication

(ral tablet3 10;23000mg recommendeonce daily +ith food and titrate dose

%: hypoglycemia3 57Bs symptoms


15/26

Weight 'ossPharmacotherapy()*+ "#$ate


16/26

What is significant +eight lossC

%ustained loss of 8 or more generallconsidered to be clinically meaningful

7nitial responders tend to continue torespondo 7nitial nonresponders less li#ely to e"er resp

o 7f 2#g 4.4 lbs not lost in the first 4 +ee#s3 uto respond at all


17/26

Pharmacologic &lasses

Pharmacologic strategies for +eight redu oradrenergic agents

57 lipase inhibition

%erotonin receptor agonists &ombination therapy

N- use$ as a$/unct to com#rehens

lifestyle intervention


18/26

oradrenergic agents

or Eshort-termF use only 12 +ee#so Phentermine

o Diethylpropion

o Phendimetra/ineo Gen/phetamine

%chedule 2 controlled substances shou

ne"er be used for +eight loss


19/26

57 lipase inhibition

(rlistato !dministered = times per day at meals

o 'eads to e,cretion of of =0 of ingested fat

Prescription strength - ?enical 120mg

(6& product - !lli 0mg

?D(% trialo &linical trial data for up to 4 years of use

o %ignificant decrease in ris# of de"eloping DM


20/26

%erotonin receptor agonis'orcaserin Gel"iH

o %electi"e serotonin 2& 8-A62c receptor ago

%imilar mechanism of action to fenfluram

o Data in up to 2 years of use

o %ignificant decrease in GP3 6&3 'D'3 and 65o Ial"ulopathy not statistically higher in lorca

treatment group3 but numerically higher

D! reHuested post-appro"al trial

o D & at +ee# 12 if +ei ht loss has not ach


21/26

&ombination therapy

Phentermine;6opiramate e,tended releasymia

*eHuires titration to target doses

*M% programo Med5uide and registered pro"ider;pharma

o *is# of fetal malformations

D;& if =-8 +t loss not reached in 12


22/26

&ombination therapy

altre,one;Gupropion e,tended release&ontra"e

*eHuires titration to target doses

D;& if 8 decrease in +eight not achieafter 12 +ee#s at maintenance dosage

Pt should be opioid free for minimum

days 14 days for buprenorphine;meth


23/26

Weight 'oss in DM

(rlistat: ?D(%o Decreased ris# of progression to DM-77

'orcaserin: G'((M-DMo => achie"ed 8 +eight loss "s 1 for place

o 7mpro"ed Agb!1&

Phentermine;topiramate: &(U* tro 2 to >0 achie"ed 8 +eight loss "s 21 f

o Decreased ris# of progression to DM-77 for hig


24/26

Aerbal %upplements

'oo# outJo Aigh li#elihood of interaction +ith prescript

+eight loss medications

o Potential for "ery serious ad"erse effects

o When possible3 herbal supplements should

a"oided completely +hile ta#ing *, +eight l

7f not3 pro"ider should re"ie+ indi"idual


25/26

*eferencesZoungas S, Chalmers J, Neal B, et al. Follow-up of blood-pressure lowering and glucose control in tpe ! diabetes. N "ngl J #ed !$%&' ()%*%(+!.

eissman N, Carr #C, e J, et al. /01#2N &* randomised clinical trial comparing once-wee3l albiglutide and insulin glargine in patients with tpe

controlled with metformin with or without sulfonlurea. 5iabetologia !$%&.

http*66www.ema.europa.eu6ema6inde7.8sp9curl:pages6medicines6human6medicines6$$!)(;6human$.htm ?0ccessed on September %+, !$%&A.

http*66www.ema.europa.eu6ema6inde7.8sp9curl:pages6medicines6human6medicines6$$!>!;6smops6ositie6human


26/26

*eferencesanos3i SZ, anos3 J0. Dong-term drug treatment for obesit* 0 sstematic and clinical reiew. JAMA!$%&'(%%?%A*)&->@.

orgerson JS, /auptman J, Boldrin #N, S8GstrGm D. H"Nical in the preention of diabetes in obese sub8ects ?H"N52SA stud*

orlistat as an ad8unct to lifestle changes for the preention of tpe ! diabetes in obese patients. 5iabetes Care. !$$&'!)?%A*%;;

Smith S1,eissman NJ, 0nderson C#, et al' Behaioral #odification and Dorcaserin for 2erweight and 2besit #anagement

roup. #ulticenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med!$%$'(@(?(A*!&;-!;@.

Fidler #C, SancheI #, 1aether B, et al' BD2SS2# Clinical rial roup. 0 one-ear randomiIed trial of lorcaserin for weight los

oerweight adults* the BD2SS2# trial. J Clin Endocrinol Metab!$%%'+@?%$A*($@)-($)).

2Neil #, Smith S1,eissman NJ, et al. 1andomiIed placebo-controlled clinical trial of lorcaserin for weight loss in tpe ! dia

BD22#-5# stud. Obesity?Siler SpringA !$%!'!$?)A*%&!@-%&(@.

adde K#, 0llison 5B, 1an 5/, et al. "ffects of low-dose, controlled-release, phentermine plus topiramate combination on we

comorbidities in oerweight and obese adults ?C2NLE"1A* a randomised, placebo-controlled, phase ( trial. Lancet !$%%'())?+

are , 1an 5/, Doo3 #, et al. wo-ear sustained weight loss and metabolic benefits with controlled-release phentermin

and oerweight adults ?S"LE"DA* a randomiIed, placebo-controlled, phase ( e7tension stud.Am J Clin Nutr!$%!'+;?!A*!+)-(

Cai7Ms 0, 0lbert D, Capel , 1igla #. Naltre7one sustained-release6bupropion sustained-release for the management of obesit*

date. Drug Design, Development and Therapy!$%&*> %&%+O%&!).

whs pr symposium - pharmacotherapy for diabetes and weight management

Documents