Liraglutide - Second Line Option in the Treatment of DM-2 or NOT.

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Radha Manian
Liraglutide - Second Line Option in the Treatment of DM-2 or NOT.

My response to the question will be NO - Liraglutide based on the Leader trial cannot be added in the algorithm of DM-2 treatment as a second line agent next to Metformin.  The logic is as follows:

Goal of DM-2 treatment is to lower the A1C value and BG level by adding another agent to the first line.  Already the pt is at 8.1 or more.  The LEADER trial discussed does not provide the outcome on these two parameters (not even the script providing the trail information), though the focus of the trial is clearly stated as "outcome of the CV and related events".  However, to make a general decision on the overall disease management, one needs the primary information on how well the basic disease is controlled.  I believe, you understand my point: Two different topics are addresssed here; presenting data on CV outcome; but questioning on decision about an add on therapy of the underlying disease state.  To me it is like "Comparing Apples and Oranges".

However, LEADER trial data clearly shows benefit of adding Liraglutadie to Metformin (add-on therapy) in diabetics with CV risk or even with mild CV risk assessment score.  In this patient population, Liraglutide can be added as a second-line agent only to reduce CV risk outcomes.  For adequate A1c/blood glucose control another antihyperglycemic agent need to be added to the algorithm( if Lirglutadie is not effective; we don't have data on this main question).  Need data to decide on Liraglutide position as a second line agent to treat DM-2.