====== Liraglutide ======

Liraglutide is a once-daily GLP-1 receptor agonist used for Type 2 Diabetes, obesity, and cardiovascular risk reduction.

Brand names:
  * Victoza (Type 2 Diabetes)
  * Saxenda (Obesity)

→ [[endocrine:glp1:start|GLP-1 Receptor Agonists Overview]]

===== Mechanism of Action =====

Liraglutide activates the GLP-1 receptor.

Effects:

  * Increases glucose-dependent insulin secretion
  * Decreases glucagon secretion
  * Slows gastric emptying
  * Increases satiety
  * Promotes weight loss

Net clinical effects:

  * Decreases HbA1c
  * Reduces body weight
  * Reduces major adverse cardiovascular events

Low hypoglycemia risk unless combined with insulin or sulfonylureas.

===== Indications =====

==== Type 2 Diabetes Mellitus ====

  * Glycemic control
  * Cardiovascular risk reduction

==== Obesity ★ ====

  * Chronic weight management
  * Reduces visceral adiposity
  * Improves metabolic risk factors

==== Atherosclerotic Cardiovascular Disease (ASCVD) ★ ====

Liraglutide reduces:

  * Myocardial infarction
  * Stroke
  * Cardiovascular death

→ [[cardio:intro:start|Cardiovascular Modules]]

===== Major Trial =====

LEADER Trial:

  * Reduced cardiovascular death
  * Reduced major adverse cardiovascular events
  * Demonstrated mortality benefit in high-risk patients

===== Dosing =====

  * Once-daily subcutaneous injection
  * Titrate gradually to minimize GI side effects

No oral formulation.

===== Adverse Effects =====

Common:

  * Nausea
  * Vomiting
  * Diarrhea
  * Early satiety

Serious (rare):

  * Pancreatitis
  * Gallbladder disease
  * Theoretical risk of medullary thyroid carcinoma

===== Contraindications =====

  * Personal or family history of medullary thyroid carcinoma
  * MEN2 syndrome
  * Severe gastrointestinal disease

Use caution in:

  * History of pancreatitis

===== Liraglutide vs Other GLP-1 Agents =====

[[endocrine:glp1:exenatide|Exenatide]]

  * Shorter-acting options available
  * Less robust ASCVD data

[[endocrine:glp1:dulaglutide|Dulaglutide]]

  * Weekly injection
  * Strong primary prevention data

[[endocrine:glp1:semaglutide|Semaglutide]]

  * Greater weight loss
  * Oral formulation available
  * Strong ASCVD data

Liraglutide:

  * First GLP-1 to show mortality reduction
  * Daily dosing

===== GLP-1 vs SGLT2 =====

Liraglutide:

  * Strong ASCVD reduction
  * Modest weight loss
  * Minimal heart failure benefit

[[endocrine:sglt2:start|SGLT2 Inhibitors]]:

  * Strong heart failure benefit
  * Strong renal protection

===== Clinical Pearls =====

  * First GLP-1 with proven CV mortality reduction
  * Daily injection
  * Useful in obesity and diabetes
  * Not a primary heart failure therapy

===== Related =====

  * [[endocrine:glp1:start|GLP-1 Receptor Agonists]]
  * [[endocrine:sglt2:start|SGLT2 Inhibitors]]
  * [[cardio:intro:start|Cardiovascular Modules]]