Endocrine Abstracts

Introduction: Dulaglutide (Trulicity^®) is a long-acting GLP-1 agonist that received US Food and Drug Administration (FDA) approval in 2014. Dulaglutide is a large sized molecule, which limits its renal clearance. This allows for once weekly dosing; which might improve patient compliance significantly. Extensive Phase III study data have been published with regard to dulaglutide, much of which was part of the AWARD studies, which provide evidence for its use in combination with several other antidiabetic agents.

Objective: The objective of the study was to evaluate the efficacy and tolerability of dulaglutide 1.5mg in patients with type 2 Diabetes, used in monotherapy and in combination with several agents including insulin.

Design and Methods: We present a restrospective, descriptive study. The included subjects were non pregnant adults with type 2 diabetes, who started on dulaglutide between March 2016 and September 2018. Patients were evaluated at 3, 6 and 12 months after the drug was started. Patients with less than 3 month follow-up were excluded.

Results: Data from 82 patients were analysed. Average age was 50.2±9.09 years old with an average of diabetes duration of 9.87±8.07 years. 13 patients (16.3%) were previously on treatment with another GLP-1RA and 52.4% were on insulin therapy. Patients enrolled were uncontrolled, with a baseline A1c of 8.6%±1.5. Throughout the 12-month study period great reduction in A1C was found (−1.5% at 3 month follow-up, which is mantained at 6 and 12 month follow up (−1.4 and −1.6% respectively)). An average weight reduction of −4.2 kg was observed throughout the study, specially at 6 month follow-up (−5.7 Kg). All results were statiscally significant (P<0.01). Only in 9.75% of the subjects (n=8), dulaglutide was discontinued due to nausea, vomiting, and diarrea, well-known dependent side effects of dulaglutide. In 4 subjets the drug was stopped because no efficacy was observed in terms of A1C and weight reduction.

Conclusions: Dulaglutide represents a well-tolerated and efficacious option in the treatment of T2DM. It is a viable second-line option after metformin, with demonstrated superior efficacy to other second-line agents. Ongoing trial data will better inform the future place in the therapy of dulaglutide considering the recent guideline emphasis on agents with beneficial effects on CV outcomes.

References

1. Thompson AM, et al. Advances in the treatment of type 2 diabetes: impact of dulaglutide. Diabetes Metab Syndr Obes. 2016;9:125–136.

2. Scheen AJ. Dulaglutide for the treatment of type2 diabetes. Expert Opin Biol Ther. 2017;17(4):485–496.