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NEW DRUG DEVELOPMENTS

Pramlintide for the Treatment of Diabetes Mellitus

Primary Care Pharmacy Practice Resident, Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia, Philadelphia College of Pharmacy, Philadelphia, PA

Eva M Vivian, PharmD BCPS CDE

Associate Professor of Clinical Pharmacy, Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia

Reprints: Erika L Kleppinger PharmD, Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia, Philadelphia College of Pharmacy, 600 S. Forty-Third St., Philadelphia, PA 19104-4495, FAX 215/596-8586, E-mail e.kleppi{at}usip.edu

OBJECTIVE: To provide an overview of the role of amylin, as well as that of pramlintide, a synthetic analog of amylin, in maintaining glucose homeostasis; and discuss the pharmacology, pharmacokinetics, efficacy, adverse effects, and role of pramlintide in the control of postprandial hyperglycemia.

DATA SOURCES: The data presented in this review were obtained from published literature, abstracts presented at scientific meetings, and information on file with the manufacturer. MEDLINE searches (1986–March 2003) using the search terms pramlintide and amylin were conducted to identify clinical trials and review articles. Additionally, the bibliographies of the identified articles were reviewed.

DATA SYNTHESIS: Clinical trials have demonstrated that amylin in combination with insulin controls postprandial glucose levels by decreasing food intake, slowing gastric emptying, and suppressing glucagon secretion. Clinical trials also showed significant decreases in mean plasma glucose levels and glycosylated hemoglobin, as well as the added benefits of weight loss and reduction in insulin doses. The most commonly reported adverse effects associated with pramlintide in clinical trials were gastrointestinal complaints and hypoglycemia, which occurred most frequently during initiation of therapy.

CONCLUSIONS: The administration of insulin alone often does not result in optimal metabolic control. The treatment of amylin deficiency, in addition to insulin deficiency, may be warranted in order to obtain glucose homeostasis. The role of pramlintide, an amylin analog, will become clearer as more clinical data become available.

Key Words: amylin, diabetes mellitus, postprandial hyperglycemia, pramlintide

Published Online, June 6, 2003. www.theannals.com, DOI 10.1345/aph.1C387

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-020-H01

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