Briefing Note: liraglutide (Victoza)

SMC accepted liraglutide for the treatment of adults with type 2 diabetes mellitus with inadequate glycaemic control (blood sugar levels) in combination with:

• metformin or a sulphonylurea despite maximum tolerated dose of monotherapy with metformin or sulphonylurea
• metformin and a sulphonylurea, or metformin and a thiazolidinedione despite dual therapy. Liraglutide is restricted for use as a third-line antidiabetic agent.
• Diabetes mellitus is a condition in which there is too much sugar present in the blood. Type 2 diabetes develops when the body does not make enough insulin (a hormone which helps sugar to be used by the body) or the insulin that is produced does not work properly. Keeping blood sugar levels as near to normal as possible reduces the risk of long-term diabetes complications such as heart disease, blindness, stroke and kidney failure.
• Liraglutide is a member of a new class of antidiabetic drugs called glucagon-like peptide-1 (GLP-1) analogues. GLP-1 analogues lower blood sugar levels by stimulating the release of insulin only when blood sugar levels are raised and not during periods of normal or low bloodsugar concentrations. Liraglutide is administered as a once-daily injection under the skin of the abdomen, the thigh or the upper arm.
• Five randomised controlled studies showed that liraglutide was effective in reducing glycated haemoglobin level (average blood glucose level over the past 2–3 months) from baseline after 26 weeks of treatment compared with relevant comparators.
• Diarrhoea, nausea and vomiting were most frequently reported with liraglutide, and were more common when liraglutide was given in combination with metformin. These side effects appeared to be related to dose. Overall the rate of serious side effects appeared lower in the liraglutide group; however for a few side effects, the number was higher in the non-liraglutide group.
• SMC accepted liraglutide as a third-line antidiabetic agent because it offers good value for money. However, it was not accepted for second-line use when added to metformin in place of a sulphonylurea because of uncertainty in the economic case submitted by the manufacturer which meant the drug was not value for money.