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GLP-1 enhances insulin secretion and may enhance myocardial performance via the combined effects of enhanced insulin secretion and action [insulin therapy has been demonstrated to have beneficial effects of its own on the course of myocardial infarction in patients with type 2 diabetes (341)], but also appears to have direct effects that are independent of insulin action
Both effects worsen CSF dynamics
Skipping doses can interrupt the gradual metabolic improvements
The commercial window for first-mover C&G therapy developers may therefore extend well beyond the 12-year BPCIA reference product exclusivity period, simply because the regulatory pathway for competition does not yet exist in operational terms
