Delving into the Latest Updates on Exenatide with Synapse

Overview

Basic Info

Drug Type

Synthetic peptide

Synonyms

EXENATIDE SYNTHETIC, Exenatide (JAN/USAN/INN), Exendin-4

+ [20]

Target

GLP-1R

Action

agonists

Mechanism

GLP-1R agonists(Glucagon-like peptide 1 receptor agonists)

Therapeutic Areas

Endocrinology and Metabolic DiseaseRespiratory Diseases

Active Indication

Diabetes Mellitus, Type 2Diabetes MellitusHypertension, Pulmonary

Inactive Indication

Coronary Artery DiseaseDiabetes ComplicationsDiabetes Mellitus, Type 1+ [13]

Originator Organization

Eli Lilly & Co.

Amylin Pharmaceuticals, Inc.

Active Organization

Aerami Therapeutics, Inc.

Icure Pharmaceutical Inc.Eli Lilly Nederland BV

+ [3]

Inactive Organization

AstraZeneca PLC

Intarcia Therapeutics, Inc.

Eli Lilly & Co.

+ [1]

Drug Highest PhaseApproved

First Approval Date

United States (28 Apr 2005),

Diabetes Mellitus, Type 2

RegulationOrphan Drug (European Union), Priority Review (China)

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Structure/Sequence

Sequence Code 751

Source: *****

To assess whether there is a difference in endogenous insulin secretion, measured as stimulated C-peptide secretion (area under the curve during a 4-hour mixed meal tolerance test), at the 1 year visit, for study subjects receiving combinational therapy versus those receiving placebo. The study will also examine the effect of the proposed treatments on immunological outcomes, specifically proportion of regulatory T cells at the 1 year visit.

Start Date01 Jan 2025

Sponsor / Collaborator

University of Miami

[+1]

NCT05663515

/ RecruitingNot Applicable

EXCEED - A Pan-European Post-Authorisation Safety Study: Risk of Pancreatic Cancer Among Type 2 Diabetes Patients Who Initiated Exenatide as Compared With Those Who Initiated Other Non-Glucagon-Like Peptide 1 Receptor Agonists Based Glucose Lowering Drugs

EXCEED is a non-interventional post-authorisation safety study aiming to assess the risk of developing pancreatic cancer among type 2 diabetes mellitus (T2DM) patients who initiated exenatide compared to those who initiated other non-glucagon like peptide 1 receptor agonists (GLP-1 RA) based glucose lowering drugs (GLDs). Study data will be collected from secondary data sources across 7 European countries. The study will be conducted as a multi-country, long-term, retrospective, observational database study. Initiators of exenatide will be matched to initiators of non-GLP-1 RA based GLDs (comparator group) based on propensity score and calendar period of study entry. All analyses for pancreatic cancer will be conducted in the matched study population using an "intention-to-treat" approach. The study will use information from 8 data sources in 7 European countries (France, Spain, The United Kingdom, Finland, Denmark, Norway, and Sweden). Patients with T2DM, aged 18 years or older, who initiated treatment with exenatide or non-GLP-1 RA based GLDs during the study period, 2006 to 2023, will be included. Exposure to exenatide and non-GLP-1 RA based GLDs will be ascertained from recordings of prescriptions or insurance claims registrations as available in the different data sources. The outcome of pancreatic cancer will be defined as a primary diagnosis of pancreatic cancer during follow-up.

Start Date30 Sep 2024

Sponsor / Collaborator

AstraZeneca PLC

[+1]

NCT06252623

/ RecruitingPhase 1IIT

A Human Laboratory Study of Exenatide for Reducing the Reinforcing Effects of Cocaine

This study will determine the safety and tolerability of exenatide (Bydureon®) as a pharmacotherapy for cocaine use disorder. An inpatient human laboratory study will be conducted in which the self-administration of cocaine, as well as the subjective and physiological effects of cocaine, are evaluated during maintenance on placebo and exenatide.
Although exenatide (Bydureon) is approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes, it has not been approved by the FDA to treat cocaine use; therefore, it is called an investigational drug.

Start Date01 Aug 2024

Sponsor / Collaborator

Baylor College of Medicine

100 Clinical Results associated with Exenatide

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100 Translational Medicine associated with Exenatide

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100 Patents (Medical) associated with Exenatide

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4,779

Literatures (Medical) associated with Exenatide

01 Dec 2025·Current Neurology and Neuroscience Reports

Special Considerations in the Treatment of Idiopathic Intracranial Hypertension

Review

Author: Friedman, Deborah I

PURPOSE OF REVIEWTo review the management of Idiopathic Intracranial Hypertension (IIH) with co-existing conditions affecting therapy: obesity, sulfa allergy, nephrolithiasis, and pregnancy.RECENT FINDINGSThe IIH-WT trial showed that bariatric surgery is currently the most effective method for obese patients with IIH to lose weight, leading to normalization of CSF pressure in many cases. Allergy to sulfonamide antibiotics does not preclude the use of acetazolamide; rather, penicillin allergy or multiple drug allergies are the strongest predictor of a hypersensitivity reaction. Carbonic anhydrase inhibitors should be avoided in individuals with a personal history of nephrolithiasis; the risk of renal stones increases with concomitant use of other medications with the potential for nephrolithiasis. Glucagon-like peptide-1 receptor antagonists (GLP-1RA) are promising non-surgical weight loss options although preliminary studies have not demonstrated considerable impact on papilledema, headache or vision. Women with IIH have high rates of pregnancy complications partly related to obesity. Recommendations for weight gain or loss during gestation are controversial. Recent studies show better outcomes in obese women who maintain or lose weight while pregnant including gestational diabetes, pre-eclampsia and emergency caesarian section. Progress continues in the search for the cause and best treatments for IIH. Larger multicenter trials of GLP-1RA are needed to determine their efficacy.

16 Mar 2025·Postgraduate Medical Journal

Effects of new hypoglycemic drugs on patients with heart failure: a systematic review and network meta-analysis

Article

Author: Song, Ruirui ; Sun, Songtao ; Shi, Xiaojing ; Chen, Jun ; Gao, Hongmei ; Liu, Fang

AbstractBackgroundCurrently, there is no relevant study comparing sodium-dependent glucose transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and dipeptidyl peptidase inhibitor (DPP4i) head to head to evaluate their comprehensive impact on heart failure patients.MethodsWe conducted a comprehensive literature search across multiple databases. Utilizing the risk of bias tool from the Cochrane Collaboration, the methodological quality of included studies was critically assessed and potential publication bias was examined via funnel plots.ResultsAll results are presented as mean difference; 95% confidence interval (MD; 95% CI). The network meta-analysis indicated that in regards to left ventricular function, there is a big difference in the left ventricular ejection fraction (LVEF) of Empagliflozin 25 mg (13.64; 0.26, 27.01) compared to Canagliflozin 100 mg; and significant differences in the left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of Dapagliflozin 10 mg (−0.76; −1.27, −0.25 and −0.95; −1.86, −0.05), Vildagliptin 50 mg (−1.05; −1.47, −0.63 and −1.12; −2.19, −0.05), and Sitagliptin 100 mg (−1.34; −2.31, −0.38 and −1.89; −3.50, −0.27) compared to Empagliflozin 10 mg. In terms of the quality of life, there are significant differences in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the Quality of life score of Sitagliptin 100 mg (408.08; 213.59, 602.57 and 3.74; 1.57, 5.92) compared to Dapagliflozin 5 mg. In terms of the cardiovascular outcome events, there is a significant difference in the heart failure rehospitalization rate of Dapagliflozin 10 mg (0.45; 0.25, 0.82) and Empagliflozin 10 mg (0.48; 0.28, 0.81) compared to Liraglutide 1.8 mg. Further significant differences are found in the all-cause mortality of Dapagliflozin 10 mg (0.81; 0.66, 0.98) compared to Vildagliptin 50 mg; the cardiovascular death of Albiglutide 30 mg (0.49; 0.28, 0.86) compared to Exenatide 2 mg; and the arrhythmic events of Liraglutide 1.8 mg (0.49; 0.26, 0.90) compared to Empagliflozin 10 mg. The network meta-analysis of SGLT2i, GLP-1RA, and DPP4i as a class of drugs showed that GLP-1RA is superior to SGLT2i in improving LVEF and reducing myocardial infarction/acute coronary syndrome, whereas DPP4i is superior to SGLT2i in improving LVEDV and LVESV.ConclusionsGLP-1RA is superior to SGLT2i in improving LVEF and reducing myocardial infarction/acute coronary syndrome, whereas DPP4i is superior to SGLT2i in improving LVEDV and LVESV.Key message What is already known on this topic—It has been confirmed that three new hypoglycemic drugs have a protective effect on the cardiovascular system. Studies have shown that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) can improve cardiovascular outcomes and enhance the quality of life of heart failure patients. Currently, SGLT2i is widely used in the clinical treatment of heart failure, and related studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase inhibitor (DPP4i) also play important roles in the treatment of heart failure. What this study adds—However, there is no relevant research on whether these drugs’ clinical efficacy is dose-dependent. How this study might affect research, practice, or policy—This study included different doses of hypoglycemic drugs and used a network meta-analysis method to comprehensively evaluate the effects of three hypoglycemic drugs on heart function, quality of life, and prognosis in heart failure patients, providing a basis for clinical practice.

01 Mar 2025·Transplantation Proceedings

Tolerability and Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists in Lung Transplant Recipients: A Single Center Report

Article

Author: Christie, Jason D ; Anderson, Michaela R ; Claridge, Tamara ; Walshe, Ciara ; Fishman, Claire E ; Witek, Stephanie ; Diamond, Joshua M ; Pandya, Krishna

INTRODUCTIONDiabetes and obesity increase risk of death after lung transplantation. Optimal treatment of diabetes and obesity may improve post-transplant outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are FDA-approved to treat diabetes and obesity and demonstrate improvement in renal and cardiovascular outcomes in the general population. However, side effects may limit tolerability in lung transplant recipients. We hypothesized that GLP-1RA would be stopped due to side effects in a higher proportion of lung transplant recipients compared to the general population but result in weight loss for those who were able to tolerate them.METHODSWe performed a single-center case series of lung transplant recipients initiated on a GLP-1RA post-transplant between April 1, 2005 and December 31, 2023. We assessed side effects and complications during GLP-1RA use. Weight was assessed at time of GLP-1RA initiation and 3-, 6-, and 12-months postinitiation.RESULTSFifty-nine lung transplant recipients initiated a GLP-1RA during the study period with a median (IQR) total time of use of 590 (280-891) days. Thirty-seven percent (22/59) stopped the medication due to side effects, with nausea and vomiting being most common. The median (IQR) percent change in weight at 12-months post-GLP-1RA initiation was -2.5% (-8.7% to 1.5%).DISCUSSIONWe report the largest study evaluating GLP-1RA use in lung transplant recipients. Discontinuation rates are higher and weight loss is lower than in the general population. However, most lung transplant recipients tolerated long-term use of GLP-1RA. Further work is required to identify which recipients are most likely to benefit and how to optimize tolerability.

95

News (Medical) associated with Exenatide

13 Mar 2025

·www.pharmaceutical-technology.com

Vivani treats first patient with long-lasting drug implant for weight loss

The device, dubbed NPM-115, is a miniature sub-dermal implant that delivers exenatide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). Image credit: Shutterstock / Formatoriginal. A day after announcing a business split-off to focus on weight loss and diabetes implants, Vivani Medical has implanted the first patient with its device. The procedure is part of a first-in-human clinical trial in Australia called LIBERATE-1 (NCT05670379) evaluating the implant in obese or overweight individuals. The company’s other implant called NPM-119 is being developed for type 2 diabetes treatment. Shares in the Nasdaq-listed company rose by 5% at market open compared to a pre-announcement market close. Shares in Vivani were already elevated after it revealed plans yesterday to spin-off its neurostimulation business Cortigent as a publicly traded company. The move is expected to facilitate both companies prioritising their respective product pipelines. The NPM-115 device is a miniature sub-dermal implant that delivers exenatide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). Vivani says the drug has demonstrated good drug release both in vitro and in animal models. The implant is designed to last for six months. The LIBERATE-1 study, which Vivani also revealed is now fully enrolled, is investigating NPM-115’s safety, tolerability, and full pharmacokinetic profile in obese or overweight subjects. Participants will first be given injections of Novo Nordisk’s popular GLP-1RA medication Wegovy (semaglutide) for two months, then one of three treatments – Vivani’s implant, weekly injections of AstraZeneca’s branded exenatide medication for diabetes Bydureon BCise, or weekly Wegovy doses. Vivani will assess changes in weight through a nine-week duration, with top-line data slated to be available in mid-2025. GLP-1RAs have become one of the dominant forces in the pharmaceutical sector. Wegovy is forecast to generate sales of $19.4bn by 2030, according to analysis by GlobalData. Eli Lilly’s rival compound Zepbound (tirzepatide), which has demonstrated slightly better efficacy, is predicted to go even further , seeing sales of $25.2bn by the same year. Whilst their use has skyrocketed amongst overweight patients, the necessity for regular injections has been a source of adherence issues. A real-world study on just under 4,800 patients on GLP-1RA medication found that around half were non-adherent. Vivani believes its long-lasting drug candidate could provide an alternative option that improves medication adherence and reduces administration burden. Vivani’s CEO Adam Mendelsohn said: “About half of people regularly miss doses as indicated by real-world medication adherence data. “Missed doses not only lead to suboptimal efficacy but can also exacerbate tolerability issues. We believe our miniature, ultra long-acting implants, designed to improve medication adherence, have the potential to improve efficacy and minimise tolerability issues.”

27 Feb 2025

·firstwordpharma.com

Medicare spending on popular diabetes meds jumps over 350% in five years

Medicare Part D spending on leading diabetes medications has reached unprecedented levels, with expenditure skyrocketing from $7.7 billion in 2019 to $35.8 billion in 2023 — translating to a 364% increase over the five-year period, according to newly released data.Auditors from the US Department of Health and Human Services' Office of Inspector General (OIG) identified and analysed Medicare Part D data for 10 widely prescribed type 2 diabetes medications, comprising seven GLP-1s and three SGLT-2 inhibitors, across the US and five overseas territories between January 2019 and December 2023. The analysis looked at utilisation metrics and spending patterns, drawing comparisons with metformin as a baseline therapy. GLP-1s lead uptickDuring the audit period, Medicare Part D expenditure for selected drugs totalled $92.8 billion, with six medications exhibiting substantial spending increases, led by GLP-1 products. Spending on Novo Nordisk's Rybelsus (semaglutide) jumped from $366,000 in 2019 to approximately $1.7 billion by 2023 — a 2182% increase — whereas Ozempic (semaglutide) expenditures increased nearly 16-fold from $552 million to $9.2 billion over the same period, with the number of beneficiaries receiving the medication rising by 929%. Meanwhile, Eli Lilly's Mounjaro (tirzepatide) showed 1541% spending growth in just its second year of coverage.The OIG noted that given a number of the medicines are commonly used off-label for other conditions, notably obesity, their increased use warrants "further inquiry to determine whether…the associated drugs were utilised for medically accepted indications." Meanwhile, TD Cowen analyst Rick Weissenstein suggested that "the data brief may provide ammunition for HHS Secretary Robert Kennedy Jr. and others who see the surge in GLP-1 use as a symptom of 'overmedication' more generally in the US."In contrast, use and spending on Novo's Victoza (liraglutide), Johnson & Johnson's Invokana (canagliflozin), as well as AstraZeneca's Byetta (exenatide) and Bydureon (exenatide extended-release), declined from 2019 to 2023, likely due to the introduction of newer alternatives. In addition, metformin expenditure decreased by 5% from $661 million in 2019 to $628 million in 2023.Spending growth outpaces enrolmentAccording to the analysis, the growth of the selected medications significantly outpaced the 12% increase in Medicare Part D enrolment during the same timeframe, raising concerns about the long-term financial sustainability of the programme. The report suggests that even if spending grows at the minimum observed annual rate of 42% during the five-year period, it could exceed $102 billion for the 10 drugs in 2026. “This substantial increase could have a financial impact on the Medicare programme,” the auditors noted in the report, adding that these findings “may be beneficial to CMS and other policymakers when developing future programme guidance related to these drugs.”Both Ozempic and Rybelsus made it on to the expanded list of medicines selected for the second round of Medicare price negotiations, drawn up by the outgoing Biden administration last month.

26 Feb 2025

·www.drugs.com

Nonarteritic Anterior Ischemic Optic Neuropathy Increased With Semaglutide

WEDNESDAY, Feb. 26, 2025 -- For individuals with type 2 diabetes (T2D), semaglutide is associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to a study published online Feb. 20 in JAMA Ophthalmology . Cindy X. Cai, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a retrospective study across 14 databases to examine the potential association between semaglutide and NAION. Adults with T2D taking semaglutide, other glucagon-like peptide 1 receptor agonists (GLP-1 RAs; dulaglutide and exenatide), or non-GLP-1 RA medications (empagliflozin, sitagliptin, and glipizide) from Dec. 1, 2017, to Dec. 31, 2023, were included. Of 37.1 million individuals with T2D, there were 810,390 new semaglutide users. The researchers found that among semaglutide users, the incidence rate of NAION was 14.5 per 100,000 person-years. Using the sensitive NAION definition, the hazard ratio for NAION among new users of semaglutide was not different compared with that of the non-GLP-1 RA medications empagliflozin, sitagliptin, and glipizide. Using the specific definition, the risk was higher for semaglutide users compared with patients taking empagliflozin (hazard ratio, 2.27). The risk for NAION was increased in a self-controlled case series analysis of semaglutide exposure (meta-analysis incidence rate ratio, 1.32). "In the absence of a known mechanism for this association, we urge clinicians to weigh the concern for an increased risk of a rare but potentially blinding eye condition with the many therapeutic benefits of semaglutide," the authors write. Several authors disclosed ties to industry. Abstract/Full Text Editorial (subscription or payment may be required) Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Clinical Result

100 Deals associated with Exenatide

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External Link

KEGG	Wiki	ATC	Drug Bank
D04121	Exenatide	A10BJ01	DB01276

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
Diabetes Mellitus, Type 2	United States	AstraZeneca AB	28 Apr 2005

Developing

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Diabetes Mellitus, Type 2	Preclinical	Hungary	Eli Lilly & Co.	01 Aug 2002
Obesity	Discovery	United States	AstraZeneca PLC	22 Mar 2016
Heart Failure	Discovery	France	AstraZeneca PLC	01 May 2015
Heart Failure	Discovery	France	Eli Lilly & Co.	01 May 2015
Hyperglycemia	Discovery	France	Eli Lilly & Co.	01 Jan 2015
Hyperglycemia	Discovery	France	AstraZeneca PLC	01 Jan 2015
Coronary Artery Disease	Discovery	Czechia	Eli Lilly & Co.	01 Jun 2011
Ventricular Dysfunction, Left	Discovery	Czechia	Eli Lilly & Co.	01 Jun 2011
Hypoglycemia	Discovery	Germany	AstraZeneca PLC	01 Feb 2007
Diabetes Mellitus, Type 2	Discovery	Hungary	Eli Lilly & Co.	01 Aug 2002

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Clinical Result

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04232969 (Pubmed) Manual	Phase 3	Parkinson Disease	194	exenatide	(krzgrzgslm) = qcgzdmkfvq kqxbschorb (zxtmskuwhh, 11.2) View more	Negative	04 Feb 2025
				placebo	(krzgrzgslm) = fjpigqdych kqxbschorb (zxtmskuwhh, 11.4) View more
NCT01107717 (EDICT, CTgov)	Phase 4	Diabetes Mellitus, Type 2	318	exenatide+pioglitazone+metformin (Triple Therapy)	(kbwqfbihse) = xegluuaeap picikkqwqb (ubabhbqugy, elzkjgecbe - rxwerttpmn) View more	-	05 Sep 2024
				glargine+metformin+glyburide (Conventional Therapy)	(kbwqfbihse) = wgxozeqzlv picikkqwqb (ubabhbqugy, qfpiapmqsk - lwzwcvzequ) View more
NCT03029351 (1981, CTgov)	Phase 4	Kidney Diseases \| Diabetes Mellitus, Type 2 \| Proteinuria	15	Exenatide Extended Release for Inj Susp 2 MG (Exenatide Extended Release)	muklaqdsum(bzoknyaxaz) = lbihtikubh kybermtgug (idpcvctktr, fsdjdnvqsh - vgoayuwwkz) View more	-	16 Apr 2024
				Placebo (Placebo)	muklaqdsum(bzoknyaxaz) = fcehfzpwhc kybermtgug (idpcvctktr, zqivxphsnt - xyirfiyfhe) View more
NCT02962492 (CTgov)	Not Applicable	Diabetes Mellitus, Type 1	70	Placebo (Placebo Arm:)	guhsqdwzni(minxtgtyjs) = fwkafympmj iiyxrieakh (plwruusawv, umguferkeh - vejxiqlnys) View more	-	29 Feb 2024
				Dapagliflozin (Dapagliflozin Arm:)	guhsqdwzni(minxtgtyjs) = titsasfatn iiyxrieakh (plwruusawv, tjgmpacugz - bnfdtgrbqa) View more
NCT01524705 (FLAT-SUGAR, CTgov)	Phase 4	Diabetes Mellitus, Type 2	102	Insulin Glargine+Metformin+Exenatide	snrfuyrqkl(exacbzdsot) = ybwswxxixl mkauwonesp (ooxidgptak, ykkofferxc - eckocqiwqb) View more	-	29 Dec 2023
NCT02621489 (Rebuild study, ESC2023)	Phase 4	Diabetes Mellitus, Noninsulin-Dependent, 2	38	Bydureon	vzsrujedbq(rhevpvwpfu) = knmlagvvve pwydalkpxz (wmryxkcbcq ) View more	-	25 Aug 2023
				Standard treatment	vzsrujedbq(rhevpvwpfu) = nnfpzrikbf pwydalkpxz (wmryxkcbcq ) View more
NCT03331289 (CTgov)	Phase 4	Diabetes Mellitus, Type 2	107	Placebo (Placebo)	rxuaeievis(xmtkcqrpxs) = xwreqicvql tmhuxukcla (ubacfeqrdo, pndflyvttu - osiudcahhk) View more	-	24 Jul 2023
				Exenatide (Exenatide)	rxuaeievis(xmtkcqrpxs) = yhlnqykfia tmhuxukcla (ubacfeqrdo, wmqjdobxet - mtanooxzxa) View more
NCT02981069 (CTgov)	Phase 4	Diabetes Mellitus, Type 2	90	Dapagliflozin (Dapagliflozin)	paicwnecro(ggivjdowou) = bfjbyzbbyz xyomumcnsi (nztlilfjpm, nvrwjbtcjq - ewxukgkomi) View more	-	20 Jul 2023
				Placebo (Placebo)	paicwnecro(ggivjdowou) = fwnsjpjcbm xyomumcnsi (nztlilfjpm, ieyrzsyxjj - ocvfciicwb) View more
ADA2023	Not Applicable	-	256	Exenatide	awfnpiqayo(vdelwzsnam) = sgllsvbgsx qwvswgjike (rhdzpyfmah ) View more	-	23 Jun 2023
				Dulaglutide	awfnpiqayo(vdelwzsnam) = ttymvrzkwo qwvswgjike (rhdzpyfmah ) View more
ADA2023	Not Applicable	-	-	Exenatide via RP	gjxjcqaqpn(indfumlflu) = rhzacufrwi ylrrdhgltt (gyhlayeroz )	-	20 Jun 2023
				Byetta via endoscopic, transenteric injection	gjxjcqaqpn(indfumlflu) = bcfkifzlkx ylrrdhgltt (gyhlayeroz )

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Exenatide

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