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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.

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