Exenatide 摘要 林口長庚紀念醫院藥劑部藥師牛素珍 陳琦華 陳偉立 2 exenatide (incretin hormone-based) GLP-1 receptor agonist exenatide 2 exenatide (HbA1c) exenatide 壹 前言 2009 exenatide (byetta) 貳 病例 一 病人資料 50 170 145 2011 9 5 2 334 mg/dl (HbA1c) 9.2% 210 mg/dl 298 mg/dl (creatinine 0.75 mg/dl) (regular HM insulin: actrapid) 8 (NPH human insulin: insulatard) 8 metformin 1 2 amaryl M metformin 1 2 sitagliptin 2011 9 20 2011 12 5 135 125 mg/dl 164 mg/dl 6.8% 102/67 mmhg 143 mg/dl 121 mg/dl 30 2 藥學雜誌 119 59 臨床藥物治療學探討 Exenatide 治療糖尿病案例
Therapeutics of Clinical Drugs 臨床藥物治療學2012 3 8 136.3 表一門診用藥記錄 2011/12/5 2012/3/8 2012/4/5 2012/9/20 2013/1/10 2013/5/23 Bisoprolol hemifumarate 5 mg/tab 1 pc qd 1 pc qd DC DC DC DC Caduet (Amlodipine 5 mg + Atorvastatin 10 mg) 1 pc qd 1 pc qd DC DC DC DC Co-Diovan (Valsartan 160 mg + HCTZ 12.5 mg) 1 pc qd 1 pc qd DC DC DC 1 pc qd Metformin 500 mg/tab 2 pc 1 pc 1 pc bid 1 pc bid 1 pc bid 1 pc bid DC Sitagliptin 100 mg/tab 1 pc qd DC Amaryl M tab (Glimepiride 2 mg+metformin 500 mg) 1 pc qd 1 pc qd 1 pc qd 1 pc qd 1 pc qd 2 pc qd Exenatide (5) 0.25 mg/ml, 1.2 ml/pc 5 mcg bid DC Exenatide (10) 0.25 mg/ml, 2.4 ml/pc 10 mcg bid 10 mcg bid 10 mcg bid 10 mcg bid Acarbose 50 mg/tab 2 pc bid 141/93 mmhg exenatide 5 mcg 1 2012 4 5 exenatide 5 mcg 10 mcg 1 2012 5 3 128.9 165/100 mmhg 111 mg/dl 6.2% 2012 10 5 128.9 165/97 mmhg 423 mg/dl 2013 5 4 130.6 127/77 mmhg 197 mg/dl 6.2% 2013 6 23 exenatide 表二檢驗數值 2011/9/5 2011/12/5 2012/5/3 2012/10/5 2013/5/4 kg 145 135 128.9 128.9 130.6 mg/dl 125 114 241 82 mg/dl 334 164 111 423 197 (HbA1c) % 9.2 6.8 6.2 6.7 mg/dl 210 143 192 181 145 HDL-C mg/dl 38 37 34 37 38 LDL-C 129 88 138 93 78 (direct) mg/dl mg/dl 298 121 168 272 144 mmhg 102/67 165/100 165/97 127/77 Creatinine (B) mg/dl 0.75 0.82 0.79 0.78 0.7 ALT/GPT U/L 109 38 29 63 26 (-) 參 討論 (IDF Intermational Diabetes Federarion) 1 8% 2025 8.9% 2 300 140 6% (metformin and thiazolidinedione) (sulfonylurea agent and meglitinide) ( -glucosidase inhibitor and DPP-4 inhibitor) GLP-1 (Glucagon-like-peptide-1) agonist 2 (ADA American Diabetes Association) 3 (EASD European Association for the Study 60 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.2
Exenatide metformin HbA1c 7% sulfonylurea HbA1c 1.5-2% sulfonylurea meglitinide HbA1c 1-1.5% sulfonylurea meglitinide (Glucagon-like-peptide-1 GLP-1) (incretin) GLP-1 (distalileum) (colon) GLP-1 GLP-1 ( -cell) ( -cell) GLP-1 GLP-1 Exenatide Gila Monster 39 GLP-1 53% (4.5-35.7%) (8-44%) (4-18%) (6-18%) (3-7%) 4 Exenatide 5 mcg 60 ( 60 6 6 ) 臨床藥物治療of Diabetes) exenatide 10 mcg 學 Exenatide DDP- 4 inhibitor metformin exenatide 3 一 Exenatide 在臨床使用有幾種情形 ( 一 )Exenatide 單一使用在肥胖糖尿病人效果 2008 Klonoff DC. exenatide 2 3 5 217 58 10 exenatide 3.5 8.2 1% 1.1 0.1% 99.3 1.2 kg 5.3 0.4 kg (P < 0.0001) 12% (p = 0.0003) 5% 6% 24% ( 二 )Exenatide 合併 metformin 或 metformin 合併 sulfonylurea 使用效果 2009 Gao Y exenatide 2 metformin metformin sulphonylurea 6 exenatide metformin (exenatide ) metformin sulfonylurea (placebo ) 466 54 9 68.7 11.2 8.3 藥學雜誌 119 61 30 2
臨床藥Therapeutics of Clinical Drugs 物治療 1.1% exenatide 學 1.2% placebo 0.4% 7% exenatide 48% placebo 17% exenatide 1.2 placebo 0.1 25% exenatide exenatide 1.8 placebo 4.7 ( 三 )Exenatide 合併胰島素使用對體重的影響 2010 Tzef M. pharmacotherapy GLP-1 2 7 188 exenatide 8.05% 117.8 99.9 6 0.66% 2.4 18 6-12 0.55% 4.3 14.8 12-18 0.54% 6.2 18-27 0.54% 5.5 12 18 exenatide 肆 結論 HbA1c 7% sulfonylurea meglitinide exenatide metformin sulfonylurea 145 130.6 9.2% 6.7% 210 mg/dl 145 mg/dl 129 mg/dl 78 mg/dl 298 mg/dl 144 mg/dl 109 U/ L 26 U/L exenatide 62 THE JOURNAL OF TAIWAN PHARMACY Vol.30 No.2
臨床藥物治療學 探討 Exenatide 治療糖尿病案例 Exenatide in Diabetes Mellitus Therapy: A Case Report Su-Chen Niu, Chi-Hua Chen, Wei-Li Chen Department of Pharmacy, Chang Gung Memorial Hospital Abstract Type 2 diabetes is a progressive disease and a therapeutic challenge. In most antidiabetes agents hypoglycemia and weight gain often limit the use of agents. The incretin hormonebased therapies are novel therapeutic agents: GLP-1 receptor agonist exenatide in patients with type 2 diabetes has been proved to be effective in glycemic control. We discussed a case to compare the change in HbA1c, body weight T- cholesterol, triglyceride, hepatic data, before and after treatment with exenatide twice daily. All test results were reduced so that treatment is to make the patient feel satisfied. 參考資料 1. 2. 3. 4. 5. Intermational Diabetes Federarion:www.idf.org.diabetesatlas. ADA: American Diabetes Association:www./tma/tw/ltk. EASD: European Association for the Study of Diabetes: www.easd.org Byetta dosing. Indication interaction. adverse effect: www,medscape.com. byetta Klonoff DC, Buse JB,Nielsen LL,et al: Exenatide effects on diabetes, obesity, cardiovascular risk factors and hepatic 6. 7. biomarkers in patients with type 2 diabetes treated for at least 3 years.curr Med Res Opin 2008; 24(1): 275-86. Gao Y, Yoon KH, Chuang LM, et al: Efficacy and safety of exenatide in patients of Asian descent with type 2 diabetes inadequately controlled with metformin or metformin and a sulphonylurea. Diabetes Research and clinical practice 2009; 83: 69-76. Tzef M.Olin JL. Glucagon-like peptide-1 analog and insulin combination therapy in the management of adults with type 2 diabetes mellitus. Annals of Pharmacotherapy 2010; 44: 1294-1300. 第 30 卷第 2 期 藥學雜誌 第119冊 63