Efpeglenatide
Long-acting exendin-based GLP-1 receptor agonist studied in a large cardiovascular-outcomes trial (AMPLITUDE-O), where it reduced cardiovascular events in high-risk type 2 diabetes.
01 Overview
Efpeglenatide is a once-weekly GLP-1 receptor agonist derived from exendin-4 and fused to an antibody Fc fragment for prolonged half-life. Though not widely marketed, it has a strong evidence base from the AMPLITUDE-O cardiovascular outcomes trial.
In AMPLITUDE-O, efpeglenatide reduced major adverse cardiovascular events and kidney outcomes in people with type 2 diabetes at high cardiovascular risk, adding to evidence for GLP-1 cardiorenal benefits. It also produces weight loss and glycaemic improvement typical of the class.
02 Mechanism
Exendin-4-based GLP-1 receptor agonist, stimulating glucose-dependent insulin secretion, suppressing glucagon and appetite, with an Fc-fusion extending half-life.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Trial dose | 4–6 mg/wk | SubQ | Doses used in AMPLITUDE-O outcomes trial |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Reduced cardiovascular eventsSignificant MACE reduction in AMPLITUDE-O. | -27% MACE | Clinical | |
| Weight loss and glycaemic controlClass-typical metabolic effects. | Modest weight loss, HbA1c reduction | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Gastrointestinal effectsNausea, vomiting and diarrhoea, more with exendin-based agonists. | Moderate | Very common | Clinical | |
| Injection-site reactionsLocal reactions typical of exendin-based peptides. | Mild | Common | Clinical |