What are the name brand GLP-1 (Glucagon-Like Peptide-1) receptor agonists?

Name Brand GLP-1 Receptor Agonists

The FDA-approved name brand GLP-1 receptor agonists currently available include exenatide (Byetta for twice-daily, Bydureon for once-weekly), liraglutide (Victoza for diabetes, Saxenda for weight loss), dulaglutide (Trulicity), semaglutide (Ozempic for weekly injection, Wegovy for weight loss, Rybelsus for oral formulation), lixisenatide (Adlyxin), and albiglutide (Tanzeum, though no longer available), plus the dual GIP/GLP-1 agonist tirzepatide (Mounjaro for diabetes, Zepbound for weight loss). 1, 2, 3, 4, 5

Short-Acting Formulations

Twice-daily administration:

• Exenatide (Byetta) - administered subcutaneously twice daily, was the first GLP-1 receptor agonist approved by the FDA in 2005 1, 4, 5

Once-daily administration:

• Lixisenatide (Adlyxin) - daily subcutaneous injection 5, 6
• Liraglutide (Victoza/Saxenda) - daily subcutaneous injection; FDA approved at 3 mg daily for weight loss in 2014 for patients with BMI >30 or >27 with comorbidities 1, 3, 5

Long-Acting Formulations

Once-weekly administration:

• Exenatide extended-release (Bydureon) - encapsulated in microspheres for gradual release from subcutaneous depot 1, 5
• Dulaglutide (Trulicity) - available in 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg single-dose pens with maximum recommended dose of 4.5 mg weekly 2, 5
• Semaglutide (Ozempic/Wegovy) - FDA approved at 2.4 mg weekly for weight loss in 2021; demonstrated 14.9% mean body weight reduction in the STEP trial 1, 5
• Albiglutide (Tanzeum) - no longer commercially available 1, 5

Oral formulation:

• Oral semaglutide (Rybelsus) - daily oral preparation with clinical effectiveness approaching the once-weekly subcutaneous formulation 1, 5

Dual GIP/GLP-1 Receptor Agonist

• Tirzepatide (Mounjaro/Zepbound) - once-weekly injection that binds both GIP and GLP-1 receptors, producing greater HbA1c and weight reductions than semaglutide and dulaglutide, with mean weight loss of 15% at 72 weeks and up to 20.9% at higher 15 mg doses 1

Key Distinguishing Features

Agents with proven cardiovascular benefit (critical for patients with established cardiovascular disease or high risk):

• Liraglutide, dulaglutide, and injectable semaglutide demonstrated cardiovascular benefit in large outcome trials 1
• The LEADER trial showed liraglutide reduced cardiovascular death, non-fatal MI, or stroke by 13% (RR 0.87,95% CI 0.78-0.97) 1
• The SUSTAIN-6 trial demonstrated semaglutide reduced the same composite outcome with RR 0.74 (95% CI 0.58-0.95) 1

Agents with renal benefits:

• Lixisenatide, exenatide (once weekly), liraglutide, semaglutide, albiglutide, dulaglutide, and efpeglenatide showed favorable CKD outcomes in cardiovascular trials 1
• Dulaglutide produced significantly slower GFR decline compared to insulin glargine in patients with moderate-to-severe CKD 1

Important Clinical Caveats

All GLP-1 receptor agonists share a boxed warning regarding thyroid C-cell tumors observed in rodent studies and are contraindicated in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 2

Gastric emptying effects vary by formulation:

• Short-acting agents (exenatide twice-daily, lixisenatide) maintain more pronounced effects on delaying gastric emptying during long-term treatment 1, 5
• Long-acting agents show tachyphylaxis to gastric emptying effects over time, though they have more profound effects on fasting glucose and HbA1c 1, 5

Contraindications and precautions:

• Not recommended in patients with severe gastrointestinal disease including severe gastroparesis 2
• Avoid in patients with recent heart failure decompensation 1
• Use with caution in patients at risk for pancreatitis 2