dulaglutide (Trulicity)
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Introduction
Indications
- treatment of diabetes mellitus type 2
- may be used in combination with metformin
- may reduce cardiovascular risk[5]
- 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
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]
More general terms
References
- ↑ 1.0 1.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25018121 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960976-4/fulltext
- ↑ 2.0 2.1 Tucker ME FDA Approves Once-Weekly Dulaglutide for Type 2 Diabetes. Medscape. Sept 18, 2014 http://www.medscape.com/viewarticle/831969
- ↑ 3.0 3.1 FDA News Release. Sept. 18, 2012 FDA approves Trulicity to treat type 2 diabetes http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415180.htm
- ↑ 4.0 4.1 4.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26009229 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60936-9/abstract
- ↑ 5.0 5.1 5.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/31189509 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31150-X/fulltext - ↑ 6.0 6.1 6.2 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 - ↑ 7.0 7.1 7.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/34153270 https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00142-X/fulltext - ↑ 8.0 8.1 NEJM Knowledge+ Endocrinology
- ↑ TRULICITY (dulaglutide) injection, for subcutaneous use HIGHLIGHTS OF PRESCRIBING INFORMATION http://pi.lilly.com/us/trulicity-uspi.pdf