Xiaflex Improves Debilitating Hand Condition

NEW DRUGS Victoza Is a New Contender In the Diabetes Arena A drug that helps the pancreas make more insulin has been approved. Lira glutide (Victoza, Novo Nordisk), an incretin mimetic, imitates naturally occurring hormones that encourage insulin production after meals. In comparative trials with exenatide (Byetta, Amylin/ Lilly), a twice-daily incretin mimetic already prescribed for initial or stand-alone therapy, once-daily liraglutide was significantly better at reducing hypoglycemia. Weight loss was another potential benefit; in one study, liraglutide patients lost an average of 3.24 kg, compared with 2.87 kg for the exenatide patients. In five clinical trials involving nearly 4,000 people, adverse effects were similar to but potentially less severe than those of exenatide. Common side effects from liraglutide were headache, nausea, and diarrhea; other adverse ef fects included allergy-like reactions such as hives. However, pancreatitis occurred more often with liraglutide than with other diabetes drugs. People with a history of pancreatitis, gallstones, alcoholism, or elevated triglyceride levels may be at higher risk. In animal studies, liraglutide caused tumors of the thyroid gland; some of these tumors were cancers, although the dose was eight times higher than what humans would receive. Because it isn’t known whether liraglutide can cause thyroid tumors or medullary thyroid cancer, the drug should not be used as a first-line treatment until more studies are completed. This agent is not recom mended for patients at risk for medullary thyroid cancer or those with multiple endocrine neoplasia syndrome type 2. Sources: Lancet 2009;374:39–47; Pharmacotherapy 2009;29:43S-54S; http:// forecast.diabetes.org/print/ node/1920; FDA, January 25, 2010 Xiaflex Improves Debilitating Hand Condition The FDA has approved Auxilium’s Xiaflex (collagenase Clostridium histo lyt icum) as the first drug to treat a progressive hand disease, Dupuytren’s contracture. Before the approval of Xiaflex, the only effective therapy was surgery. Patients have an abnormal thickening of the fibrous layer underneath the skin of the palm and fingers. Too much collagen can build up, forming thick, ropelike cords of tissue that can prevent the fingers from being able to relax and straighten normally. The disorder is most common in men older than 50 years of age and in people of northern European descent. Xiaflex, a biologic agent, breaks up the collagen deposits. It is injected directly into the collagen cord of the hand. This drug should be administered only by a health care professional experienced with injections of the hand, because tendon ruptures may occur. Although no serious allergic reactions have been observed, introducing this drug, which is a foreign protein, could prompt an immune system reaction. Sources: N Engl J Med 2009;361:968; FDA, February 3, 2010; Associated Press