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Trulicity ® (dulaglutide)
This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information. For current prescribing information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk (England, Scotland, Wales) or www.emcmedicines.com/en-GB/northernireland/ (Northern Ireland).
What information is available about switching between Trulicity® (dulaglutide) to other GLP-1 receptor agonists like semaglutide or liraglutide?
Available practical advice for switching between dulaglutide and other GLP-1 RAs is mainly based on clinical experience. Below, the current evidence has been summarised.
Table of contents
- What is the available evidence about the switch between dulaglutide and other GLP-RAs in general?
- What is the available evidence about the switch between dulaglutide and semaglutide?
- What is the available evidence about the switch between dulaglutide and liraglutide?
- How to select the new GLP-1 RA, and what are some general considerations?
- Is a washout needed and what should be the initial dose of the new GLP-1 RA?
- Will the patient tolerate and respond to the new GLP-1 RA?
- What advice and information will the patient need?
- What is relevant when switching from or to dulaglutide?
- Treatment decision
What is the available evidence about the switch between dulaglutide and other GLP-RAs in general?
Eli Lilly and Company has not sponsored any studies on the effects of switching between dulaglutide and other glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Therefore, we cannot provide any specific recommendations.
To identify possible published evidence and recommendations on how to switch between GLP-1 RAs in general, a literature search was completed on the 21st of November 2022 in the biomedical database Ovid Embase®. We searched for publications related to glucagon-like peptide-1 receptor agonists mentioning “GLP-1 RAs” and “switch” in the title. The search found 44 publications, that were manually screened to remove publications not related to a switch between GLP-1 RAs. A total of 10 publications met our criteria.
Database: Embase <1974 to 2022 November 21>
- (glucagon* or GLP*).m_titl. (24803)
- "switch*".m_titl. (51828)
- exp glucagon like peptide 1 receptor agonist/ (43352)
- 1 and 2 and 3 (44)
- from 4 keep 2,4-6,9,14-15,19-20,42 (10)
What is the available evidence about the switch between dulaglutide and semaglutide?
Eli Lilly and Company has not sponsored any studies on the effects of switching between dulaglutide and semaglutide.4
To identify possible published evidence and recommendations on how to switch between dulaglutide and semaglutide, a literature search was completed on the 16th of August 2023 in the biomedical database Ovid Embase®. We searched for publications related to dulaglutide and semaglutide mentioning “switch” in the title. The search found 6 publications, that were manually screened to remove publications not related to a switch between dulaglutide and semaglutide. A total of 5 publications met our criteria.
Database: Embase <1974 to 2023 August 15>
- dulaglutide.m_titl. (723)
- semaglutide.m_titl. (1323)
- "switch*".m_titl. (54648)
- 1 and 2 and 3 (6)
- from 4 keep 2-6 (5)
The 5 results included 3 publications focusing on the switch from dulaglutide to semaglutide5-7, and 1 focusing on the switch from semaglutide to dulaglutide8. These studies are briefly summarised below with a focus on the switching between the products. For further information on the results of the studies, please consult the individual publications.
Two of the publications were multicentre, open-labelled, prospective, randomized, parallel-group comparison studies.
- They aimed to compare the effects of once-weekly subcutaneous semaglutide against liraglutide 0.9–1.8 mg/day or dulaglutide 0.75 mg/weekly on glycemic control in 100 Japanese patients with T2D.
- Patients treated with liraglutide or dulaglutide were either switched to semaglutide or continued current therapy.
- The primary endpoint was the mean change in glycated haemoglobin over 24 weeks.
- Participants in the semaglutide group followed a semaglutide dose-escalation regimen (0.25 mg semaglutide was administered once weekly for 4 weeks and then the maintenance dose of 0.5–1.0 mg was administered).5,6
The other publication focusing on the switch from dulaglutide to semaglutide was a retrospective real-world effectiveness analysis.
- The study included 164 adults with T2D who prior to switching to semaglutide , were on a stable dose of liraglutide or dulaglutide.
- A change in HbA1c was the primary outcome.
- Of the 25 patients on dulaglutide once-weekly at the time of the switch, 2 (8%) and 23 (92%) patients were on dulaglutide doses of 0.75 and 1.5 mg/week, respectively.
- The median doses of dulaglutide once-weekly prior to switching were 1.5 mg/week.
- At the time of the switch, patients were started on the following semaglutide once-weekly doses:
- 48 (29.3%) 0.25 mg/week
- 106 (64.6%) on 0.5 mg/week and
- 10 (6.1%) on 1.0 mg/week.
- The final recorded dose of semaglutide on study completion for the 147 patients, who had continued on the medication was:
- 0.25 mg/week for 1 patient (0.6%),
- 0.50 mg/week for 32 patients (21.8%), and
- 1.0 mg/week for 114 patients (77.6%).
- The median final dose of semaglutide once-weekly was 1.0 mg/week.7
The last publication focuses on the switch from semaglutide to dulaglutide, and evaluated HbA1c and body weight changes when semaglutide 0.5- or 1.0-mg once-weekly is switched to dulaglutide 3.0- or 4.5-mg once-weekly via exposure-response modelling.8
What is the available evidence about the switch between dulaglutide and liraglutide?
Eli Lilly and Company has not sponsored any studies on the effects of switching between dulaglutide and liraglutide.4
To identify possible published evidence and recommendations on how to switch between dulaglutide and liraglutide, a literature search was completed on the 17th of August 2023 in the biomedical database Ovid Embase®. We searched for publications related to dulaglutide and liraglutide mentioning “switch” in the title. The search found 5 publications, that were manually screened to remove publications not related to a switch between dulaglutide and liraglutide. A total of 2 publications met our criteria.
Database: Embase <1974 to 2023 August 16>
- dulaglutide.m_titl. (723)
- liraglutide.m_titl. (3776)
- "switch*".m_titl. (54656)
- 1 and 2 and 3 (5)
- from 4 keep 1,5 (2)
The first publication discusses an open-label, prospective, randomized, parallel-group controlled trial
- 30 Japanese patients with type 2 diabetes treated with once-daily liraglutide (0.6 or 0.9 mg) were randomly switched to
- liraglutide (0.5 mg once-weekly) or
- dulaglutide (0.75 mg once weekly) group.
- Post-treatment, changes in the HbA1c level from baseline to weeks 8, 16, and 26 were evaluated.9
The second publication focuses on a 12-week, multicenter, open-label, prospective, randomized, parallel-group comparison trial.
- The study included 31 Japanese patients with type 2 diabetes, who were being administered liraglutide once-daily for >3 months.
- The patients were randomly assigned to either switch to dulaglutide 0.75 mg once weekly or continue taking 0.9 mg liraglutide once daily.
- Changes in the Diabetes Treatment Satisfaction Questionnaire score from baseline to week 12 was the primary outcome.10
How to select the new GLP-1 RA, and what are some general considerations?
Physicians should follow their clinical judgment, taking into account the patient’s glycaemic response and needs when deciding how to transition from one GLP-1 RA to another.4
Is a washout needed and what should be the initial dose of the new GLP-1 RA?
When should the new GLP-1 RA be administered?
Dosing and posology of new GLP-1 RA
Adhere to the label of the new GLP-1 RA for information on recommended posology.1
A lower starting dose might be considered if gastrointestinal adverse events need consideration. A low initial and more slowly increase in dose might help to mitigate this type of undesirable effects. Adverse gastrointestinal effects at initiation or up-dosing are usually temporary.2
A higher starting dose might be considered in specific situations, for example in patients on high maintenance doses and good tolerance of the previous GLP-1 RA and/or patients who fear losing glycaemic control.2 Depending on the new GLP-1 RA, the initiation at a higher dose might be off-label.
Up-titration is essential to achieve glycaemic efficacy.2
A re-evaluation for tolerability and glycemia should take place after 2 to 3 months.1
Will the patient tolerate and respond to the new GLP-1 RA?
The available evidence from systematic studies is limited:
The perspectives from 10 healthcare professionals experienced with switching patients with T2D were collated, focussing on switching to once weekly semaglutide. It has been concluded that switching can provide clinical benefits. However, switching should be individualized, explaining to patients the temporary character of possible gastrointestinal events. Furthermore, a transient deterioration of glycaemic control is possible until full effect of the new GLP-1 RA’s final maintenance dose is achieved.2
A monocentric, retrospective, real-world cohort study confirmed the effectiveness and tolerability of the once-weekly GLP-1 RA in a routine clinical practice. Furthermore, switching to another once-weekly GLP-1 RA might help patients not responding to a previous GLP-1RA to achieve metabolic targets.3
What advice and information will the patient need?
Here some aspects important to discuss with the patient:
- Any concern the patient might have and why the switch is necessary.2
- How to use the new device, if applicable.1
- Changes to the dosing regimen and how often to administer the new GLP-1 RA.1
- The possibility of a transient loss of glycaemic control during dose titration and time to steady state.2
- The possibility of gastrointestinal adverse events that are usually transient and can be mitigated by smaller meal size and lower meal fat content.2
What is relevant when switching from or to dulaglutide?
For patients switching to Trulicity in combination with other antidiabetics, the recommended dose is 1.5 mg once weekly.11
In vulnerable populations, a starting dose of 0.75 mg once weekly can be considered.11
For additional glycaemic control,11
- the 1.5 mg dose may be increased after at least 4 weeks to 3 mg once weekly.
- the 3 mg dose may be increased after at least 4 weeks to 4.5 mg once weekly.
The maximum dose is 4.5 mg once weekly.11
When dulaglutide is added to existing therapy of a sulphonylurea or insulin, a reduction in the dose of sulphonylurea or insulin may be considered to reduce the risk of hypoglycaemia.11
Onset of action
Improvement in glycemic control starts after the first administration
Duration of action
Improvement in glycemic control is sustained throughout the once-weekly dosing interval
Approximately 5 days
Time to steady state
Steady state concentrations are achieved within 2 to 4 weeks.
Missing dosing information
Once steady state is achieved, missing 2 or more consecutive doses may result in subtherapeutic dulaglutide concentrations.
When transitioning a patient from one GLP-1 RA to another, the prescribing information of the applicable GLP-1 RAs and pharmacokinetic/pharmacodynamic profiles should be considered. For full prescribing information please refer to the Summary of Product Characteristics (SmPC) of both GLP-1 RAs.4
1Almandoz JP, Lingvay I, Morales J, Campos C. Switching between glucagon-like peptide-1 receptor agonists: rationale and practical guidance. Clin Diabetes. 2020;38(4):390-402. https://doi.org/10.2337/cd19-0100
2Jain AB, Ali A, Gorgojo Martínez JJ, Hramiak I, Kavia K, Madsbad S, Potier L, Prohaska BD, Strong JL, Vilsbøll T. Switching between GLP-1 receptor agonists in clinical practice: Expert consensus and practical guidance. Int J Clin Pract. 2021;75(2):e13731. https://doi.org/10.1111/ijcp.13731
3Di Dalmazi G, Coluzzi S, Baldassarre MPA, et al. Effectiveness and Tolerability of Once-Weekly GLP-1 Receptor Agonists in Clinical Practice: A Focus on Switching Between Once-Weekly Molecules in Type 2 Diabetes. Frontiers in Endocrinology. 2022 ;13:892702. https://doi.org/10.3389/fendo.2022.892702
4Data on file, Eli Lilly and Company and/or one of its subsidiaries.
5Takahashi Y, Nomoto H, Yokoyama H, et al. Improvement of glycaemic control and treatment satisfaction by switching from liraglutide or dulaglutide to subcutaneous semaglutide in patients with type 2 diabetes: A multicentre, prospective, randomized, open-label, parallel-group comparison study (SWITCH-SEMA 1 study). Diabetes Obes Metab. 2023;25(6):1503-1511. doi:10.1111/dom.14998
6Nomoto H, Oba-Yamamoto C, Takahashi Y, et al. Effects of Switching from Liraglutide or Dulaglutide to Subcutaneous Semaglutide on Glucose Metabolism and Treatment Satisfaction in Patients with Type 2 Diabetes: Protocol for a Multicenter, Prospective, Randomized, Open-Label, Blinded-Endpoint, Parallel-Group Comparison Study (The SWITCH-SEMA 1 Study). Diabetes Ther. 2021;12(3):955-964. doi:10.1007/s13300-020-00986-9
7Jain AB, Kanters S, Khurana R, et al. Real-World Effectiveness Analysis of Switching From Liraglutide or Dulaglutide to Semaglutide in Patients With Type 2 Diabetes Mellitus: The Retrospective REALISE-DM Study. Diabetes Ther. 2021;12(2):527-536. doi:10.1007/s13300-020-00984-x
8Tham LS, Pantalone KM, Dungan K, et al. A model-based simulation of glycaemic control and body weight when switching from semaglutide to 3.0- and 4.5-mg doses of once-weekly dulaglutide. Diabetes Obes Metab. 2022;24(2):302-311. doi:10.1111/dom.14582
9Iijima T, Shibuya M, Ito Y, et al. Effects of switching from liraglutide to semaglutide or dulaglutide in patients with type 2 diabetes: A randomized controlled trial. J Diabetes Investig. 2023;14(6):774-781. doi:10.1111/jdi.14000
10Takase T, Nakamura A, Yamamoto C, et al. Improvement in treatment satisfaction after switching from liraglutide to dulaglutide in patients with type 2 diabetes: A randomized controlled trial. J Diabetes Investig. 2019;10(3):699-705. doi:10.1111/jdi.12906
11Trulicity [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
Date of Last Review: 18 August 2023