Insulin Pens

Overview

Bydureon and Bydureon BCise are both once weekly injections for the treatment of diabetes, delivering 2 mg of the active ingredient exenatide per injection.


On the surface, Bydureon BCise looks as though it is simply a new and improved injector pen compared to the original Bydureon pen. However, there are some significant differences between them including:

  • Administration
  • Side effects
  • Drug levels


Below, we discuss these and more in detail.


Bydureon Vs. Bydureon BCise: The Pens

The main difference between the two products is the injector pen. Bydureon must be manually injected while the Bydureon BCise pen is an "auto-injector".


Bydureon

The original Bydureon pen is slightly more cumbersome to use for most individuals and more steps are required for appropriate administration.


Original Bydureon


Important characteristics of the Bydureon pen include:

  • The needle for injection must be physically screwed onto the device and is visible when injecting.
  • Requires vigorous mixing. The pen must be tapped against the palm up to 80 times for proper mixing.
  • Must be physically injected by pushing down on a plunger.



Bydureon BCise

The Bydureon BCise is an auto-injector and does not require the user to push down on a plunger.

Bydureon BCise


Important characteristics of the Bydureon BCise pen include:

  • Pre-attached needle. The needle is also not visible as it is shielded by part of the device.
  • Easier mixing (but still requires at least 15 seconds of vigorous shaking).
  • No need to physically push down a plunger. Simply press into your skin and hold until dosing is complete. The medication is injected "automatically".


Summary

  • The needle on Bydureon must be screwed on and is visible. The needle on Bydureon BCise is already attached to the pen and is not visible.
  • Bydureon requires slightly more vigorous mixing, although Bydureon BCise does need to be mixed for at least 15 seconds.
  • Bydureon requires you to physically push in a plunger for injection. Bydureon BCise is an auto injector and is simply pushed and held against the skin.


Bydureon Vs. Bydureon BCise: Dosing, Efficacy And Adverse Effects

Bydureon Injection


Both Bydureon and Bydureon BCise are dosed as once weekly injections with each dose delivering 2 mg of exenatide. Interestingly enough, even though they both deliver 2 mg of exenatide, plasma drug levels of each varies with Bydureon showing higher levels over time when compared to Bydureon BCise.


Bydureon BCise Plasma Levels

Bydureon BCise Blood Levels

Source: Bydureon BCise


Bydureon Plasma Levels


Bydureon Blood Levels
Source: Bydureon


There doesn't appear to be much, if any, clinical significance to these differences in drug levels as they both have similar efficacy in regard to their ability to lower HbA1C levels in individuals.


Side Effects

Their side effect profile is similar with a few notable differences:

  • Bydureon may cause more nausea. According to clinical studies, 11.3% of individuals experience nausea on Bydureon while 8.2% of individuals experienced nausea using Bydureon BCise. This may be related to the lower overall blood levels of exenatide that Bydureon BCise provides.
  • Bydureon BCise may cause more injection site reactions: According to clinical studies, 23.9% of individuals experienced injection site reactions on Bydureon BCise while 17.1% of individuals experienced injection site reactions on Bydureon.


Although technically a side effect, weight loss is one of the potential positives of using Bydureon and Bydureon BCise. According to the clinical trials referenced in each drugs respective package insert (Bydureon, Bydureon BCise):

  • Bydureon may cause more weight loss.  Average weight loss with Bydureon in clinical trials was around 2.3 kg (~5 pounds) while the average weight loss with Bydureon BCise was 1.4 kg (~3 pounds).


Bydureon Vs. Bydureon BCise: Summary

Overall, these products are very similar with their marked difference being the injection pen. In summary:

  • The Bydureon pen must be manually injected and the pen needle must be manually screwed on.
  • The Bydureon BCise pen is an auto-injector with the pen needle attached.
  • Both Bydureon and Bydureon BCise must be manually mixed but Bydureon BCise may be less cumbersome to mix.
  • Both Bydureon and Bydureon BCise are dosed once weekly and deliver 2 mg of exenatide per dose. 
  • Bydureon produces higher plasma drug levels than Bydureon BCise. This doesn't appear to be clinically significant in regard to drug efficacy.
  • Both Bydureon and Bydureon BCise have similar efficacy in regard to lowering HbA1C levels.
  • Bydureon may cause more nausea related side effects than Bydureon BCise.
  • Bydureon BCise may cause more injection site reactions than Bydureon.
  • Bydureon may cause more weight loss than Bydureon BCise.