Lixisenatide

Like exenatide, lixisenatide is a modified derivative of the lizard peptide exendin-4. Sanofi developed it as a once-daily subcutaneous medicine taken before a meal. It was sold alone as Adlyxin and is combined with insulin glargine in Soliqua.

Because insulin secretion depends on glucose, hypoglycemia risk is low when lixisenatide is used on its own. Combining it with insulin or a sulfonylurea can increase that risk.

The drug stimulates glucose-dependent insulin release, suppresses glucagon and markedly slows gastric emptying through the GLP-1 receptor. Its short duration emphasizes control of the post-meal glucose rise rather than continuous coverage, explaining pre-meal use.

ELIXA enrolled people with type 2 diabetes after a recent acute coronary syndrome and established cardiovascular safety. That finding should not be restated as demonstrated superiority for cardiovascular prevention.

FDA approved lixisenatide in 2016 for type 2 diabetes. Sanofi discontinued US standalone Adlyxin in 2023 for business reasons. Lixisenatide remains available as part of Soliqua with insulin glargine.

Its role is adult type 2 diabetes glucose control alongside diet and exercise, particularly after meals. It does not treat type 1 diabetes. Unlike long-acting GLP-1 medicines, this short-acting exendin-based agent does not carry a thyroid C-cell-tumor boxed warning.

Common reactions include nausea, vomiting, diarrhea, headache and dizziness. Serious concerns include pancreatitis, severe allergy including anaphylaxis, dehydration-related acute kidney injury and hypoglycemia, especially in combination with insulin or a sulfonylurea.