Prolonged release exenatide gets the go-ahead from NICE

he use of glucagon-like peptide-1 (GLP-1) based therapies in the treatment of type 2 diabetes has become well established in clinical practice within the UK since the launch of the first GLP-1 analogue, exenatide, in 2007 and subsequently that of liraglutide in 2009. Trends towards increased use of GLP-1 can be inferred from national prescribing data showing that the cost per item in the ‘other anti-diabetic drugs’ category, primarily consisting of GLP-1 analogues, has increased substantially by 144% since 2007, while that for other diabetes drug categories has remained fairly stable. 1 The reason for the increasing use of GLP-1 analogues probably derives from proven efficacy in lowering blood glucose levels combined with beneficial effects on weight and potentially blood pressure which is in contrast to many other therapeutic modalities in diabetes. 2 Exenatide prolonged release (EPR) is the first onceweekly GLP-1 analogue to come to the market with a UK licence (as Bydureon) for use in combination with oral antidiabetic therapy in the treatment of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) issued its single technology appraisal (STA) on the use of this agent in February 2012. 3 Based upon its analysis of the available clinical data and application of cost-effectiveness modelling, the NICE Evidence Review Group has concluded in support of the use of EPR as a cost-effective alternative to the previously established daily GLP-1 analogues, with the main additional clinical benefit being of fewer injections which could potentially reduce the impact of managing type 2 diabetes on the daily lives of patients and their carers. The recommendations for initiation and discontinuation of EPR are summarised in Table 1 and are essentially the same as those for the two established GLP-1 analogues, twice-daily exenatide and once-daily liraglutide (NICE CG87 & TA203, respectively). 4,5 Review of the evidence informing the guidance