The “incretin-based” therapies heralded a range of classes of diabetes therapy specifically designed to address an identified pathophysiology – in this case a relative deficiency in incretin effect.
Two approaches have been taken. First, the “gliptins” utilised DPP4 inhibition approaches to prolong the half-life and, hence, concentration of GLP-1 and GIP (in particular). Second, GLP-1 receptor analogues provide potent, long duration agonism of the GLP-1 receptor, irrespective of endogenous incretin production and action.
The two approaches have key similarities (both efficacious, no hypoglycaemia) and key differences (“physiology” vs. pharmacology, oral vs. S/C, AE profile, weight neutral vs, reducing). The agents have very substantial worldwide use and clinical trial experience, including cardiac outcome study results.
This experience and the results will be discussed, as will key differences and differentiators of agents between and within the two classes, including pipeline therapies.
Overall, the incretin-based therapies have proven to be a very useful addition to the therapeutic choices available to patients and clinicians.