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Glycemic Management in Type 2 Diabetes Efficacy and Safety of Antihyperglycemic Therapies Introduced Since 2004 1.

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Presentation on theme: "Glycemic Management in Type 2 Diabetes Efficacy and Safety of Antihyperglycemic Therapies Introduced Since 2004 1."— Presentation transcript:

1 Glycemic Management in Type 2 Diabetes Efficacy and Safety of Antihyperglycemic Therapies Introduced Since 2004 1

2 *P<0.001 vs active comparator monotherapy. † P<0.001 vs active comparator dual therapy. 1. Nauck MA, et al. Diabetes Obes Metab. 2007;9:194-205. 2. Goldstein BJ, et al. Diabetes Care. 2007;30:1979-1987. 3. Charbonnel B, et al. Diabetes Care. 2006;29:2638-2643. 4. Vilsbøll T, et al. Diabetes Obes Metab. 2010;12:167-177. 5. Derosa G, et al. Metab Clin Exp. 2010;59:887-895. 6. Dobs AS, et al. J Diabetes. 2013;5:68-79..  A1C (%) Glucose Control With Sitagliptin: Selected Mono and Combination Therapy Studies Monotherapy vs Glipizide 52 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Insulin 24 Weeks 4 Add-on to Pioglitazone vs Met + Pio 12 Months 5 Add-on to Rosiglitazone + Metformin 54 Weeks 6 N11721091701641151278 TreatmentSitGlipSitMetSit+ Met MetSit+ Met InsSit+ Ins Met + Pio Sit + Pio Rosi + Met Sit + Rosi + Met Baseline A1C (%) 7.5 8.98.78.88.0 8.68.78.48.58.78.8 * * * †

3 *P<0.001 vs glipizide; † P<0.05 vs sitagliptin. 1. Aschner P, et al. Diabetes Care. 2006;29:2632-2637. 2. Nauck MA, et al. Diabetes Obes Metab. 2007;9:194-205. 3. Rosenstock J, et al. Clin Ther. 2006;28:1556-1568. 4. Hermansen K, et al. Diabetes Obes Metab. 2007;9:733-745. 5. Vilsbøll T, et al. Diabetes Obes Metab. 2010;12:167-177. 6. Derosa G, et al. Metab Clin Exp. 2010;59:887-895.  Weight (kg) Weight Changes With Sitagliptin: Selected Mono and Combination Therapy Studies Monotherapy 24 Weeks 1 Monotherapy 52 Weeks 2 Add-on to Pioglitazone 24 Weeks 3 Add-on to Glimepiride 24 Weeks 4 Add-on to Insulin 24 Weeks 5 Add-on to Pio vs Met + Pio 12 Months 6 N741793353441641151 TreatmentPBOSitGlipSitPioSit + Pio GlimSit + Glim InsSit + Ins Met + Pio Sit + Pio † *

4 1. Nauck MA, et al. Diabetes Obes Metab. 2007;9:194-205. 2. Goldstein BJ, et al. Diabetes Care. 2007;30:1979-1987. 3. Charbonnel B, et al. Diabetes Care. 2006;29:2638-2643. 4. Rosenstock J, et al. Clin Ther. 2006;28:1556-1568. 5. Hermansen K, et al. Diabetes Obes Metab. 2007;9:733-745. 6. Vilsbøll T, et al. Diabetes Obes Metab. 2010;12:167-177. Hypoglycemia With Sitagliptin: Selected Studies Sitagliptin vs Glipizide 52 weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Pioglitazone 24 Weeks 4 Add-on to Glimepiride 24 Weeks 5 Add-on to Insulin 24 Weeks 6 N7931091701353441641 TreatmentSitGlipPBOMetSit + Met MetSit + Met PioSit + Pio GlimSit + Glim Sit + Glim + Met InsSit + Ins Patients Reporting Hypoglycemia (%)

5 Incidence of Selected Adverse Events With Sitagliptin: Pooled Data Adverse EventIncidence per 100 patient-yearsDifference (95% CI) Sitagliptin 100 mgNonexposed Constipation2.61.90.8 (0.1, 1.4) Diarrhea6.99.6-2.3 (-3.6, -1.0) Headache5.85.60.4 (-0.7, 1.4) Nasopharyngitis7.77.00.9 (-0.3, 2.1) Pancreatitis0.080.10-0.02 (-0.20, 0.14) Rash1.30.90.4 (-0.1, 0.8) Upper respiratory tract infection 8.69.0-0.3 (-1.6, 1.0) Williams-Herman D, et al. BMC Endocr Disord. 2010;10(7). http://www.biomedcentral.com/1472-6823/10/7. Engel SS, et al. Int J Clin Pract. 2010;64:984-990.

6 P<0.0001 vs comparator. 1. Rosenstock J, et al. Curr Med Res Opin. 2009;25:2401-2411. 2. Jadzinsky M, et al. Diabetes Obes Metab. 2009;11:611-622. 3. DeFronzo RA, et al. Diabetes Care. 2009;32:1649-1655. 4. Scheen AJ, et al. Diabetes Metab Res Rev. 2010;26:540-549. 5. Chacra AR, et al. Int J Clin Pract. 2009;63:1395-1406. 6. Hollander P, et al. J Clin Endocrinol Metab. 2009;94:4810-4819. Glucose Control With Saxagliptin: Mono and Combination Therapy Monotherapy 24 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Metformin 18 Weeks 4 Add-on to Glyburide vs Uptitration 24 Weeks 5 Add-on to TZD 24 Weeks 6 N4011306743801768565 TreatmentPBOSaxMetSax + Met MetSax + Met Sit + Met Sax + Met GlySax + Gly TZDSax + TZD Baseline A1C (%)7.98.0 9.4 8.1 7.7 8.48.58.28.4 *  A1C (%) * * * *

7 *P=0.01 vs glyburide uptitration. 1. Rosenstock J, et al. Curr Med Res Opin. 2009;25:2401-2411. 2. Jadzinsky M, et al. Diabetes Obes Metab. 2009;11:611-622. 3. DeFronzo RA, et al. Diabetes Care. 2009;32:1649-1655. 4. Scheen AJ, et al. Diabetes Metab Res Rev. 2010;26:540-549. 5. Chacra AR, et al. Int J Clin Pract. 2009;63:1395-1406. 6. Hollander P, et al. J Clin Endocrinol Metab. 2009;94:4810-4819.  Weight (kg) Weight Changes With Saxagliptin: Mono and Combination Therapy Monotherapy 24 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Metformin 18 Weeks 4 Add-on to Glyburide vs Uptitration 24 Weeks 5 Add-on to TZD 24 Weeks 6 N4011306743801768565 TreatmentPBOSaxMetSax + Met MetSax + Met Sit + Met Sax + Met GlySax + Gly TZDSax + TZD *

8 1. Rosenstock J, et al. Curr Med Res Opin. 2009;25:2401-2411. 2. Jadzinsky M, et al. Diabetes Obes Metab. 2009;11:611-622. 3. DeFronzo RA, et al. Diabetes Care. 2009;32:1649-1655. 4. Scheen AJ, et al. Diabetes Metab Res Rev. 2010;26:540-549. 5. Chacra AR, et al. Int J Clin Pract. 2009;63:1395-1406. 6. Hollander P, et al. J Clin Endocrinol Metab. 2009;94:4810-4819. Hypoglycemia With Saxagliptin: Mono and Combination Therapy Monotherapy 24 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Metformin 18 Weeks 4 Add-on to Glyburide vs Uptitration 24 Weeks 5 Add-on to TZD 24 Weeks 6 N4011306743801768565 TreatmentPBOSaxMetSax + Met MetSax + Met Sit + Met Sax + Met GlySax + Gly TZDSax + TZD Patients Reporting Hypoglycemia (%)

9 Incidence of Adverse Events With Saxagliptin Adverse Events*Patients (%) Saxagliptin 5 mgPlacebo Headache6.55.9 Upper respiratory tract infection 7.77.6 Urinary tract infection6.86.1 *Occurring in ≥5% of patients receiving saxagliptin 5 mg and more commonly than in placebo-treated patients. Onglyza (saxagliptin) prescribing information. Princeton, NJ: Bristol-Meyers Squibb. 2011.

10 * P<0.0001 vs comparator. † P<0.0001 vs placebo and vs metformin 1000 mg twice daily. HD, high-dose metformin (1000 mg twice daily); LD, low-dose metformin (500 mg twice daily). 1. Del Prato S, et al. Diabetes Obes Metab. 2011;13:258-267. 2. Haak T, et al. Diabetes Obes Metab. 2012;14:565-574. 3. Gomis R, et al. Diabetes Obes Metab. 2011;13:653-661. 4. Taskinen MR, et al. Diabetes Obes Metab. 2011;13:65-74. 5. Gallwitz B, et al. Lancet. 2012;380:475-483. 6. Owens DR, et al. Diabet Med. 2011;28:1352-61. Glucose Control With Linagliptin: Mono and Combination Therapy Monotherapy 24 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Initial Combo w/ Pioglitazone 24 Weeks 3 Add-on to Metformin 24 Weeks 4 Add-on to Metformin 2 Years 5 Add-on to Metformin + SU 24 Weeks 6 N50379138970015521055 TreatmentPBOLin Met HD Lin + Met LD Lin + Met HD PioLin + Pio MetLin + Met Glim + Met Lin + Met Met + SU Lin + Met + SU Baseline A1C (%) 8.0 8.78.58.7 8.6 8.08.17.7 8.18.2  A1C (%) * * * * †

11 Weight Changes With Linagliptin Initial Combo w/ Metformin 24 Weeks 1 Initial Combo w/ Pioglitazone 24 Weeks 2 Add-on to Metformin 24 Weeks 3 Add-on to Metformin 2 Years 4 N7913897001552 TreatmentLinMet HD Lin + Met LD Lin + Met HD PioLin + Pio MetLin + Met Glim + Met Lin + Met  Weight (kg) * P<0.0001 vs comparator. HD, high-dose metformin (1000 mg twice daily); LD, low-dose metformin (500 mg twice daily). 1. Haak T, et al. Diabetes Obes Metab. 2012;14:565-574. 2. Gomis R, et al. Diabetes Obes Metab. 2011;13:653-661. 3. Taskinen MR, et al. Diabetes Obes Metab. 2011;13:65-74. 4. Gallwitz B, et al. Lancet. 2012;380:475-483. *

12 Hypoglycemia With Linagliptin: Mono and Combination Therapy Patients Reporting Hypoglycemia (%) Monotherapy 24 Weeks 1 Initial Combo w/ Metformin 24 Weeks 2 Initial Combo w/ Pioglitazone 24 Weeks 3 Add-on to Metformin 24 Weeks 4 Add-on to Metformin 2 Years 5 Add-on to Metformin + SU 24 Weeks 6 N50379138970015521055 TreatmentPBOLin Met HD Lin + Met LD Lin + Met HD PioLin + Pio MetLin + Met Glim + Met Lin + Met Met + SU Lin + Met + SU HD, high-dose metformin (1000 mg twice daily); LD, low-dose metformin (500 mg twice daily). 1. Del Prato S, et al. Diabetes Obes Metab. 2011;13:258-267. 2. Haak T, et al. Diabetes Obes Metab. 2012;14:565-574. 3. Gomis R, et al. Diabetes Obes Metab. 2011;13:653-661. 4. Taskinen MR, et al. Diabetes Obes Metab. 2011;13:65-74. 5. Gallwitz B, et al. Lancet. 2012;380:475-483. 6. Owens DR, et al. Diabet Med. 2011;28:1352-61.

13 Incidence of Adverse Events With Linagliptin Tradjenta (linagliptin) prescribing information. Ridgefield, CT: Boehringer Ingelheim, Inc.; 2012. Adverse Events*Patients (%) Linagliptin 5 mg (n=3625) Placebo (n=2176) Nasopharyngitis7.06.1 Diarrhea3.33.0 Cough2.11.4 *Occurring in ≥2% of patients receiving linagliptin 5 mg and more commonly than in placebo-treated patients.

14 P<0.001 vs comparator(s). 1.DeFronzo RA, et al. Diabetes Care. 2008;31:2315–2317. 2. Rosenstock J, et al. Diabetes Care. 2010;33:2406–2408. 3. Nauck MA, et al. Int J Clin Pract. 2009;63:46-55.4. Pratley RE, et al. Diabetes Obes Metab. 2009;11:167-176. 5. Bosi E, et al. Diabetes Obes Metab. 2011;13:1088-1096. 6. Rosenstock J, et al. Diabetes Obes Metab. 2009;11:1145-1152. Glucose Control With Alogliptin: Mono and Combination Therapy Monotherapy 26 Weeks 1 Initial Combo w/ Pioglitazone 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Glyburide 26 Weeks 4 Add-on to Met + Pio 52 Weeks 5 Add-on to Insulin +/- Met 26 Weeks 6 N329655527500803390 TreatmentPBOAloPioAloAlo + Pio MetAlo + Met GlyAlo + Gly Met + Pio Alo + Met + Pio Ins +/- Met Alo + Ins +/- Met Baseline A1C (%) 7.9 8.8 8.07.98.1 8.39.3  A1C (%) * * * * * *

15 P<0.01 vs comparator. 1.DeFronzo RA, et al. Diabetes Care. 2008;31:2315–2317. 2. Rosenstock J, et al. Diabetes Care. 2010;33:2406–2408. 3. Nauck MA, et al. Int J Clin Pract. 2009;63:46-55.4. Pratley RE, et al. Diabetes Obes Metab. 2009;11:167-176. 5. Bosi E, et al. Diabetes Obes Metab. 2011;13:1088-1096. 6. Rosenstock J, et al. Diabetes Obes Metab. 2009;11:1145-1152. Weight Change With Alogliptin Monotherapy 26 Weeks 1 Initial Combo w/ Pioglitazone 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Glyburide 26 Weeks 4 Add-on to Met + Pio 52 Weeks 5 Add-on to Insulin +/- Met 26 Weeks 6 N329655527500803390 TreatmentPBOAloPioAloAlo + Pio MetAlo + Met GlyAlo + Gly Met + Pio Alo + Met + Pio Ins +/- Met Alo + Ins +/- Met  Weight (kg) *

16 1.DeFronzo RA, et al. Diabetes Care. 2008;31:2315–2317. 2. Nesina (alogliptin) prescribing information. Deerfield, IL: Takeda Pharmaceuticals America, Inc.; 2013. 3. Nauck MA, et al. Int J Clin Pract. 2009;63:46-55. 4. Pratley RE, et al. Diabetes Obes Metab. 2009;11:167-176. 5. Bosi E, et al. Diabetes Obes Metab. 2011;13:1088-1096. 6. Rosenstock J, et al. Diabetes Obes Metab. 2009;11:1145-1152. Hypoglycemia With Alogliptin Monotherapy 26 Weeks 1,2 Add-on to Metformin 26 Weeks 3 Add-on to Glyburide 26 Weeks 4 Add-on to Met + Pio 52 Weeks 5 Add-on to Insulin +/- Met 26 Weeks 6 N329527500803390 TreatmentPBOAloMetAlo + Met GlyAlo + Gly Met + Pio Alo + Met + Pio Ins +/- Met Alo + Ins +/- Met Patients Reporting Hypoglycemia (%)

17 Incidence of Adverse Events With Alogliptin Nesina (alogliptin) prescribing information. Deerfield, IL: Takeda Pharmaceuticals America, Inc.; 2013. Adverse Events*Patients (%) Alogliptin 25 mg (n=5902) Placebo (n=2926) Active comparator (n=2257) Nasopharyngitis4.43.05.0 Headache4.22.55.4 Upper respiratory tract infection 4.22.15.0 *Occurring in ≥4% of patients receiving alogliptin 25 mg and more commonly than in placebo-treated patients.

18  A1C (%) Glucose Control With Exenatide With/Without Oral Agents *P<0.001 vs comparator. † All exenatide dosages shown are 10 μg BID. 1. Moretto TJ, et al. Clin Ther. 2008;30:1448-1460. 2. DeFronzo RA et al. Diabetes Care. 2005;28:1092-1100. 3. Buse JB, et al. Diabetes Care. 2004;27:2628-2635. 4. Zinman B, et al. Ann Intern Med. 2007;146:477-485. 5. Kendall DM et al. Diabetes Care. 2005;28:1083-1091. 6. Heine RJ, et al. Ann Intern Med. 2005;143:559-569. Monotherapy 24 Weeks 1 Add-on to Metformin 30 Weeks 2 Add-on to Sulfonylurea 30 Weeks 3 Add-on to TZD 16 Weeks 4 Add-on to Metformin + SU 30 Weeks 5 Add-on to Met + SU vs Glargine 26 Weeks 6 N233336377233733551 Treatment†PBOExeMetExe + Met SUExe + SU TZDExe + TZD Met + SU Exe + Met + SU Glar + Met + SU Exe + Met + SU Baseline A1C (%) 8.2 8.78.67.9 8.5 8.38.2 * * * * *

19  Weight (kg) Weight Reduction With Exenatide: Mono and Dual Combination Therapy *P<0.05 vs comparator. **P<0.0001 vs glargine. † All exenatide dosages shown are 10 μg BID. 1. Moretto TJ, et al. Clin Ther. 2008;30:1448-1460. 2. DeFronzo RA et al. Diabetes Care. 2005;28:1092-1100. 3. Buse JB, et al. Diabetes Care. 2004;27:2628-2635. 4. Zinman B, et al. Ann Intern Med. 2007;146:477-485. 5. Kendall DM et al. Diabetes Care. 2005;28:1083-1091. 6. Heine RJ, et al. Ann Intern Med. 2005;143:559-569. Monotherapy 24 Weeks 1 Add-on to Metformin 30 Weeks 2 Add-on to Sulfonylurea 30 Weeks 3 Add-on to TZD 16 Weeks 4 Add-on to Metformin + SU 30 Weeks 5 Add-on to Met + SU vs Glargine 26 Weeks 6 N233336377233733551 Treatment†PBOExeMetExe + Met SUExe + SU TZDExe + TZD Met + SU Exe + Met + SU Glar + Met + SU Exe + Met + SU * * * * * **

20 *P<0.05 vs placebo. Moretto TJ, et al. Clin Ther. 2008;30:1448-1460.  Systolic BP (mmHg) Blood Pressure Changes With Exenatide Monotherapy 24 Weeks N233 TreatmentPBOExe 10 μg BID *

21 † All exenatide dosages shown are 10 μg BID. 1. Moretto TJ, et al. Clin Ther. 2008;30:1448-1460. 2. DeFronzo RA et al. Diabetes Care. 2005;28:1092-1100. 3. Buse JB, et al. Diabetes Care. 2004;27:2628-2635. 4. Zinman B, et al. Ann Intern Med. 2007;146:477-485. Patients Reporting Hypoglycemia (%) Hypoglycemia With Exenatide: Mono and Dual Combination Therapy Monotherapy 24 Weeks 1 Add-on to Metformin 30 Weeks 2 Add-on to Sulfonylurea 30 Weeks 3 Add-on to TZD 16 Weeks 4 N233336377233 Treatment†PBOExeMetExe + Met SUExe + SU TZDExe + TZD

22 Exenatide: Adverse Events Adverse Events* Patients (%) Monotherapy+ Met and/or SU+ TZD ± Met Exe (n=155) PBO (n=77) Exe (n=963) PBO (n=483) Exe (n=121) PBO (n=112) Nausea8044184015 Vomiting40134 1 Diarrhea13663 Feeling Jittery94 Dizziness96 Headache96 Dyspepsia306371 Asthenia42 GERD3130 Hyperhidrosis31 *Occurring in ≥2% of patients receiving exenatide Byetta (exenatide) injection prescribing information. San Diego, CA: Amylin Pharmaceuticals, Inc. 2011.

23 *P<0.0001 vs monotherapy. **P<0.0001 vs dual therapy. ***P=0.0015 vs glargine. † All liraglutide dosages shown are 1.8 mg QD. 1. Garber A, et al. Lancet. 2009;373:473-481. 2. Nauck M, et al. Diabetes Care. 2009;32:84-90. 3. Pratley RE, et al. Lancet. 2010;375:1447-1456. 4. Marre M, et al. Diabet Med. 2009;26:268-278. 5. Zinman B, et al. Diabetes Care. 2009;32:1224-1230. 6. Russell-Jones D, et al. Diabetologia. 2009;52:2046-2055. Glucose Control With Liraglutide With/Without Oral Agents  A1C (%) Monotherapy vs Glimepiride 52 Weeks 1 Add-on to Metformin 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Sulfonylurea 26 Weeks 4 Add-on to Met + TZD 26 Weeks 5 Add-on to Met + SU 26 Weeks 6 N74610916651041821581 TreatmentGlimLirMetGlim + Met Lira + Met Sit + Met Lira + Met SURosi + SU Lira + SU Rosi + Met Lira + Rosi + Met Met + SU Glar + Met + SU Lira + Met + SU Baseline A1C (%) 8.48.38.4 8.58.4 8.58.48.68.38.28.3 * ** * *** *

24 *P<0.0001 vs glargine, rosiglitazone, sitagliptin, or SU. **P<0.01 vs metformin. ***P<0.05 vs SU. † All liraglutide dosages shown are 1.8 mg QD. 1. Garber A, et al. Lancet. 2009;373:473-481. 2. Nauck M, et al. Diabetes Care. 2009;32:84-90. 3. Pratley RE, et al. Lancet. 2010;375:1447-1456. 4. Marre M, et al. Diabet Med. 2009;26:268-278. 5. Zinman B, et al. Diabetes Care. 2009;32:1224-1230. 6. Russell-Jones D, et al. Diabetologia. 2009;52:2046-2055.  Weight (kg) Weight Reduction With Liraglutide: Mono and Dual Combination Therapy * * * ** * * *** Monotherapy vs Glimepiride 52 Weeks 1 Add-on to Metformin 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Sulfonylurea 26 Weeks 4 Add-on to Met + TZD 26 Weeks 5 Add-on to Met + SU 26 Weeks 6 N746 10916651041821581 TreatmentGlimLir MetGlim + Met Lira + Met Sit + Met Lira + Met SURosi + SU Lira + SU Rosi + Met Lira + Rosi + Met Met + SU Glar + Met + SU Lira + Met + SU *

25 Blood Pressure Changes With Liraglutide  Systolic BP (mmHg) * * * * Monotherapy vs Glimepiride 52 Weeks 1 Add-on to Metformin 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Sulfonylurea 26 Weeks 4,5 Add-on to Met + TZD 26 Weeks 6 Add-on to Met + SU 26 Weeks 7 N746 10916651041821581 TreatmentGlimLir MetGlim + Met Lira + Met Sit + Met Lira + Met SURosi + SU Lira + SU Rosi + Met Lira + Rosi + Met Met + SU Glar + Met + SU Lira + Met + SU *P<0.05 vs comparator. † All liraglutide dosages shown are 1.8 mg QD. 1. Garber A, et al. Lancet. 2009;373:473-481. 2. Nauck M, et al. Diabetes Care. 2009;32:84-90. 3. Pratley RE, et al. Lancet. 2010;375:1447-1456. 4. Marre M, et al. Diabet Med. 2009;26:268-278. 5. Colagiuri S, et al. Diabetes. 2008;57(suppl 2): Abstr. 554-P. 6. Zinman B, et al. Diabetes Care. 2009;32:1224-1230. 7. Russell-Jones D, et al. Diabetologia. 2009;52:2046-2055

26 *P<0.01 vs active comparator. † All liraglutide dosages shown are 1.8 mg QD. 1. Garber A, et al. Lancet. 2009;373:473-481. 2. Nauck M, et al. Diabetes Care. 2009;32:84-90. 3. Pratley RE, et al. Lancet. 2010;375:1447-1456. 4. Marre M, et al. Diabet Med. 2009;26:268-278. Hypoglycemia With Liraglutide: Mono and Dual Combination Therapy Monotherapy 52 Weeks 1 Add-on to Metformin 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Sulfonylurea 26 Weeks 4 N74610916651041 Treatment†GlimLiraMetGlim + Met Lira + Met Sit + Met Lira + Met SURosi + SU Lira + SU * Patients Reporting Hypoglycemia (%) * *

27 Liraglutide: Adverse Events Adverse Events* Patients (%) Monotherapy+ Met+ Glim+ Met + TZD Lir (n=497) Glim (n=248) Lir (n=724) PBO (n=121) Lir (n=695) PBO (n=114) Lir (n=355) PBO (n=175) Nausea28.48.515.24.17.51.834.68.6 Diarrhea17.18.910.94.17.21.814.16.3 Vomiting10.93.66.50.812.42.9 Constipation9.94.85.30.95.11.1 Headache9.19.39.06.68.24.6 Dyspepsia5.20.9 *Adverse events of interest occurring in ≥5% of patients receiving liraglutide. Victoza (liraglutide) injection prescribing information. Princeton, NJ: Novo Nordisk Inc. 2012.

28 *Metformin, sulfonylurea, thiazolidinedione, or combination of any 2 of these agents. † Metformin, sulfonylurea, metformin + sulfonylurea, or metformin + pioglitazone. 1. Drucker DJ, et al. Lancet. 2008;372:1240-1250. 2. Russell-Jones D, et al. Diabetes Care. 2012;35:252-258. 3. Bergenstal RM, et al. Lancet. 2010;376:431-439. 4. Diamant M, et al. Lancet. 2010;375:2234-2243. 5. Buse JB, et al. Lancet. 2013;381:117-124. Glucose Control With Exenatide ER  A1C (%) Add-on to OAs* 30 Weeks 1 Monotherapy vs OAs 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Met +/- SU 26 Weeks 4 Add-on to OAs † 26 Weeks 5 N 258820514456911 TreatmentExe BID Exe ER SitPioMetExe ER SitPioExe ER Glar + OAs Exe ER + OAs Lira + OAs Exe ER + OAs Baseline A1C (%) 8.3 8.5 8.68.5 8.68.3 8.48.5 P<0.001 P<0.0001 P<0.01 P=0.017 P=0.02

29 *Metformin, sulfonylurea, thiazolidinedione, or combination of any 2 of these agents. † Metformin, sulfonylurea, metformin + sulfonylurea, or metformin + pioglitazone. 1. Drucker DJ, et al. Lancet. 2008;372:1240-1250. 2. Russell-Jones D, et al. Diabetes Care. 2012;35:252-258. 3. Bergenstal RM, et al. Lancet. 2010;376:431-439. 4. Diamant M, et al. Lancet. 2010;375:2234-2243. 5. Buse JB, et al. Lancet. 2013;381:117-124. Add-on to OAs* 30 Weeks 1 Monotherapy vs OAs 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Met +/- SU 26 Weeks 4 Add-on to OAs † 26 Weeks 5 N 258820514 456911 Treatment (mg/day) Exe BID Exe ER SitPioMetExe ER SitPioExe ER Glar + OAs Exe ER + OAs Lira + OAs Exe ER + OAs P<0.0001  Weight (kg) Weight Reduction With Exenatide ER P<0.001

30 *Metformin, sulfonylurea, thiazolidinedione, or combination of any 2 of these agents. † Metformin, sulfonylurea, metformin + sulfonylurea, or metformin + pioglitazone. 1. Drucker DJ, et al. Lancet. 2008;372:1240-1250. 2. Russell-Jones D, et al. Diabetes Care. 2012;35:252-258. 3. Bergenstal RM, et al. Lancet. 2010;376:431-439. 4. Diamant M, et al. Lancet. 2010;375:2234-2243. 5. Buse JB, et al. Lancet. 2013;381:117-124. Add-on to OAs* 30 Weeks 1 Monotherapy vs OAs 26 Weeks 2 Add-on to Metformin 26 Weeks 3 Add-on to Met +/- SU 26 Weeks 4 Add-on to OAs † 26 Weeks 5 N 258820514 456911 TreatmentExe BID Exe ER SitPioMetExe ER SitPioExe ER Glar + OAs Exe ER + OAs Lira + OAs Exe ER + OAs Patients reporting hypoglycemia (%) Hypoglycemia With Exenatide ER

31 Exenatide Extended Release: Adverse Events Adverse Events* Patients (%) Monotherapy+ Met+ Met +/- SU Exe ER (n=248) Sit (n=163) Pio (n=163) Met (n=246) Exe ER (n=160) Sit (n=166) Pio (n=165) Exe ER (n=233) Glar (n=233) Nausea11.33.74.36.924.49.64.812.91.3 Diarrhea10.95.53.712.620.09.67.39.44.0 Injection site reaction 10.56.73.710.25.04.81.26.00 Constipation8.52.51.83.36.33.61.2 Headache8.19.28.012.29.49.05.59.97.6 Dyspepsia7.31.84.93.35.03.62.4 Vomiting11.32.43.0 Fatigue5.60.63.0 *Adverse events of interest occurring in ≥5% of patients receiving exenatide extended release. Bydureon (exenatide extended release) injection prescribing information. San Diego, CA: Amylin Pharmaceuticals, Inc. 2012.

32 *Estimated glumerular filtration rate 30-50 mL/min/1.73 m 2. **P<0.001 vs placebo. ***P<0.05 vs placebo. † Met criteria for noninferiority and superiority (upper limit of confidence interval <0.0%). 1. Stenlof K, et al. Diabetes Obes Metab. 2013;15:372-382. 2. Rosenstock J, et al. Diabetes Care. 2012;35:1232-1238. 3. Schernthaner G, et al. Diabetes Care. 2013;April 5 epub ahead of print. 4. Yale J-F, et al. Diabetes Obes Metab. 2013;15:463-473. Glucose Control With Canagliflozin  A1C (%) Monotherapy 26 Weeks 1 Add-on to Metformin 12 Weeks 2 Add-on to Metformin + SU 52 Weeks 3 Add-on to OAs +/- Insulin in CKD* 26 Weeks 4 N 584451755269 Treatment (mg/day) PBOCan 100 Can 300 PBOSitCan 100 Can 300 SitCan 300 PBOCan 100 Can 300 Baseline A1C (%) 8.08.18.07.87.67.87.78.1 8.07.98.0 ** † ***

33 *Estimated glumerular filtration rate 30-50 mL/min/1.73 m 2. **P<0.001 vs placebo. † P<0.001 vs sitagliptin. 1. Stenlof K, et al. Diabetes Obes Metab. 2013;15:372-382. 2. Rosenstock J, et al. Diabetes Care. 2012;35:1232-1238. 3. Schernthaner G, et al. Diabetes Care. 2013;April 5 epub ahead of print. 4. Yale J-F, et al. Diabetes Obes Metab. 2013;15:463-473. Weight Change With Canagliflozin Monotherapy 26 Weeks 1 Add-on to Metformin 12 Weeks 2 Add-on to Metformin + SU 52 Weeks 3 Add-on to OAs +/- Insulin in CKD* 26 Weeks 4 N 584451755269 Treatment (mg/day) PBOCan 100 Can 300 PBOSitCan 100 Can 300 SitCan 300 PBOCan 100 Can 300 ** †  Weight (kg)

34 *Estimated glumerular filtration rate 30-50 mL/min/1.73 m 2. **P<0.001 vs comparator. 1. Stenlof K, et al. Diabetes Obes Metab. 2013;15:372-382. 2. Rosenstock J, et al. Diabetes Care. 2012;35:1232-1238. 3. Schernthaner G, et al. Diabetes Care. 2013;April 5 epub ahead of print. 4. Yale J-F, et al. Diabetes Obes Metab. 2013;15:463-473. Blood Pressure Change With Canagliflozin Monotherapy 26 Weeks 1 Add-on to Metformin 12 Weeks 2 Add-on to Metformin + SU 52 Weeks 3 Add-on to OAs +/- Insulin in CKD* 26 Weeks 4 N 584451755269 Treatment (mg/day) PBOCan 100 Can 300 PBOSitCan 100 Can 300 SitCan 300 PBOCan 100 Can 300  Systolic BP (mmHg) **

35 *Estimated glumerular filtration rate 30-50 mL/min/1.73 m 2. **P<0.001 vs placebo. ***P<0.05 vs placebo. † Met criteria for noninferiority and superiority (upper limit of confidence interval <0.0%). 1. Stenlof K, et al. Diabetes Obes Metab. 2013;15:372-382. 2. Rosenstock J, et al. Diabetes Care. 2012;35:1232-1238. 3. Schernthaner G, et al. Diabetes Care. 2013;April 5 epub ahead of print. 4. Yale J-F, et al. Diabetes Obes Metab. 2013;15:463-473. Hypoglycemia With Canagliflozin Monotherapy 26 Weeks 1 Add-on to Metformin 12 Weeks 2 Add-on to Metformin + SU 52 Weeks 3 Add-on to OAs +/- Insulin in CKD* 26 Weeks 4 N 584451755269 Treatment (mg/day) PBOCan 100 Can 300 PBOSitCan 100 Can 300 SitCan 300 PBOCan 100 Can 300 Patients reporting hypoglycemia (%)

36 Canagliflozin: Adverse Events Adverse Events* Patients (%) Canagliflozin 100 mg (n=833) Canagliflozin 300 mg (n=834) Placebo (n=646) Female genital mycotic infections10.411.43.2 Urinary tract infections5.94.34.0 Increased urination5.34.60.8 Male genital mycotic infections4.23.70.6 Vulvovaginal pruritis1.63.00 Thirst2.82.30.2 Constipation1.82.30.9 Nausea2.22.31.5 *Adverse events of interest occurring in ≥2% of patients receiving canagliflozin. Invokana (canagliflozin) prescribing information. Titusville, NJ: Janssen Pharmaceuticals, Inc. 2013.


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