Le medicament du mois. Le lixisenatide (Lyxumia): nouvel agoniste des recepteurs du glucagon-like peptide-1 a action preferentiellement post-prandiale.

Lixisenatide (Lyxumia) is a new agonist of Glucagon-Like Peptide-1 (GLP-1) receptors that is indicated in the treatment of type 2 diabetes, in one single subcutaneous daily injection of 20 microg. It exerts an incretin effect by stimulating insulin secretion after a meal while inhibiting glucagon secretion, both in a glucose-dependent manner, which limits the risk of hypoglycaemia. In addition, it slows down gastric emptying after a meal, which contributes to reduce postprandial hyperglycaemia, especially after breakfast. Lixisenatide is currently reimbursed in Belgium after failure of a dual therapy with metformin and a sulfonylurea but also in combination with a basal insulin (with or without oral antidiabetic drugs). The latter interesting combination should tackle fasting glycaemia with basal insulin (after appropriate dose titration) and postprandial hyperglycaemia with the GLP-1 receptor agonist in a complementary manner. The consequence is a further improvement of glycated haemoglobin (HbA(1c)) varying between 0.3 and 0.9% in various studies comparing lixisenatide versus placebo. As other compounds of the class, lixisenatide induces a small weight reduction, which contrasts with the weight gain commonly observed with other antidiabetic medications (including insulin). Further studies should demonstrate the effects of lixisenatide on vascular complications and overall prognosis of patients with type 2 diabetes.