Contents

Search

dulaglutide (Trulicity)

FDA-approved Sept 2014. [2,3] Indications: - treatment of diabetes mellitus type 2 - may be used in combination with metformin - may reduce cardiovascular risk [5] - 24% risk reduction for stroke vs placebo (RR=0.7) [6] - may reduce cognitive decline by 14% [6] - may reduce risk of erectile dysfunction* [7] * does not improve pre-existing erectile dysfunction [7] Contraindications: - personal or family history of medullary thyroid carcinoma - Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) - gastroparesis [8] Dosage: - 0.75-1.5 mg SQ weekly (at bedtime) Dosage adjustment with renal failure: - no adjustment needed for once weekly injection Adverse effects: - gastrointestinal distress - hypoglycemia (80%) similar to glargine [4] - dose-related increase in incidence of thyroid C-cell carcinomas, including including medullary thyroid carcinoma in rats (relevance to humans is unknown) Mechanism of action: - incretin mimetic Clinical trials: - non inferior to liraglutide in metformin-treated patients with type 2 diabetes [1] - reduces cardiovascular risk in patients with type 2 diabetes [5] - more effective than glargine in lowering HgbA1c at the cost of increased adverse effects [4]

Interactions

drug adverse effects of hypoglycemic agents

General

glucagon-like peptide 1 (GLP-1) receptor agonist; incretin mimetic; GLP-1 mimetic; GLP-1 agonist; glutide; GLP-1RA

References

  1. Dungan KM et al. Once-weekly dulaglutide versus once-daily liraglutide in metformin-treated patients with type 2 diabetes (AWARD-6): A randomised, open-label, phase 3, non-inferiority trial. Lancet 2014 Jul 11 PMID: 25018121 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960976-4/fulltext
  2. Tucker ME FDA Approves Once-Weekly Dulaglutide for Type 2 Diabetes. Medscape. Sept 18, 2014 http://www.medscape.com/viewarticle/831969
  3. FDA News Release. Sept. 18, 2012 FDA approves Trulicity to treat type 2 diabetes http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415180.htm
  4. Blonde L et al. Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): A randomised, open-label, phase 3, non-inferiority study. Lancet 2015 May 23; 385:2057 PMID: 26009229 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60936-9/abstract
  5. Gerstein HC, Colhoun HM, Dagenais GR et al Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. June 8, 2019 PMID: 31189511 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31149-3/fulltext - Gerstein HC, Colhoun HM, Dagenais GR et al Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet. June 8, 2019 PMID: 31189509 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31150-X/fulltext
  6. George J A Diabetes Drug That Slows Cognitive Decline? - Trulicity analysis hints at dementia prevention MedPage Today June 22, 2020 https://www.medpagetoday.com/neurology/dementia/87188 - Cukierman-Yaffe T, et al Effect of dulaglutide on cognitive impairment in type 2 diabetes: an exploratory analysis of the REWIND trial. Lancet Neurology, Volume 19, ISSUE 7, P582-590, July 01, 2020 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30173-3/fulltext - Biessels, GJ A first lead in dementia prevention in people with diabetes. Lancet Neurology, Volume 19, ISSUE 7, P559-560, July 01, 2020 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30174-5/fulltext
  7. Monoco K 'Modest' Erectile Dysfunction Benefit With GLP-1 Agonist. Dulaglutide didn't improve pre-existing symptoms, but did prevent some new cases. MedPage Today June 23, 2021 https://www.medpagetoday.com/endocrinology/diabetes/93250 - Bajaj HS, Gerstein HC, Rao-Melacini P et al Erectile function in men with type 2 diabetes treated with dulaglutide: an exploratory analysis of the REWIND placebo-controlled randomised trial. Lancet Diabetes Endocrinol 2021. June 18 PMID: 34153269 https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00115-7/fulltext - Madsbad S Dulaglutide for erectile dysfunction in type 2 diabetes. Lancet Diabetes Endocrinol 2021. June 18 PMID: 34153270 https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00142-X/fulltext
  8. NEJM Knowledge+ Endocrinology
  9. TRULICITY (dulaglutide) injection, for subcutaneous use HIGHLIGHTS OF PRESCRIBING INFORMATION http://pi.lilly.com/us/trulicity-uspi.pdf