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Another FDA-Approved GLP-1 Agonist – Dulaglutide (TRULICITY)

Dec 30, 2014

Earlier this year, I wrote a blog about TANZEUM – or albiglutide – as another GLP-1 agonist available for the management of type 2 diabetes.  Many practitioners seek medications that have minimal to no risk of hypoglycemia, weight neutral or loss, and an effective hemoglobin A1C reduction.  Glucagon-like peptide-1 (GLP-1) agonists have been available since 2007 with twice-daily exenatide immediate-release (BYETTA) as the first medication in this class.  A GLP-1 agonist has multiple mechanisms of action that can be benefit for a patient with type 2 diabetes.  As a review, a GLP-1 agonist increases insulin secretion from beta-cells and suppresses glucagon secretion from alpha-cells.  In addition, a GLP-1 agonist can slow gastric emptying and promote satiety.  According to the American Diabetes Association and American Association of Clinical Endocrinologists, GLP-1 agonists are appropriate second-line options if glycemic goals are not achieved after 3 months of metformin therapy.  Over the past 6 years, there have been other approved GLP-1 agonists, which include once-daily liraglutide (VICTOZA), once-weekly exenatide extended-release (BYDUREON), and once-weekly albiglutide (TANZEUM). 

In September 2014, a new GLP-1 agonist was approved for the management of type 2 diabetes mellitus.  Dulaglutide or TRULICITY is the third FDA-approved once-weekly agent in this particular class of medications.  Here are the Albiglutide is similar to exenatide extended-release.  While the full package insert is not available, here are the key points regarding albiglutide:

• Indicated as an adjunct to diet and exercise among adults with type 2 diabetes mellitus
• Has a half-life of 5 days, allowing for once-weekly administration
• Includes a warning of thyroid C-cell tumors among individuals with a personal or family history
• May cause diarrhea, nausea, and injection site reactions at a similar occurrence to other once-weekly GLP-1 agonists
• Administered in abdomen, thigh or upper arm
• Dosed as 0.75 mg or 1.5 mg per week

To me, I am very interested in learning about the injector pen.  I have not seen the pre-filled syringe, but have heard that patients will not be able to see the needle.  Therefore, the device may have an edge over exenatide extended-release and albiglutide.  In addition, I think dulaglutide is a good option as it has similar hemoglobin A1C reduction to liraglutide and exenatide extended-release with the potential of 6-lbs weight loss.  However, cost will remain a big factor.  With this new approved agent, I would reinforce that diabetes management is individualized considering efficacy, tolerability, patient preference and cost for our patients.

2 comments

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  1. Feb 11, 2015

    Injector pens sound easy enough that more patients would be receptive to using insulin to manage their dm. But as you have pointed out, cost is a huge factor and let's hope FDA can work with the Pharmaceutical companies to make such pens more affordable with good reimbursement. If done so I can see this as a win win for all of us involved in patient care and improving outcomes. Thanks for sharing
  2. Jan 05, 2015

    My endo just prescribed Trulicity for me, but warned of the nausea resulting in diarrhea, vomiting, or both. I have delayed the start for the last 2 weeks because of the dread of having to deal with this, especially at work. Now, today, I have read that this could cause tumors on my thyroid. It happens that my mother died of thyroid cancer, or at least cancer that metasticized (sp?) from the thyroid. Now I'm downright frightened. I'm not schedule to see him again until April.

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