From the Guidelines
Mounjaro (tirzepatide) is a highly effective medication for weight loss and type 2 diabetes management, with a recommended starting dose of 2.5 mg weekly, gradually increasing to a maintenance dose of 5-15 mg based on response and tolerability.
Key Points
- Mounjaro works by activating both GLP-1 and GIP receptors, which improves insulin secretion, reduces glucagon, slows gastric emptying, and increases satiety 1.
- For weight management, it helps reduce appetite and food intake, with a mean weight loss of 20.9% for 15 mg of tirzepatide at 72-week follow-up 1.
- Common side effects include nausea, vomiting, diarrhea, and stomach discomfort, which often improve over time.
- Patients should store Mounjaro in the refrigerator, inject it subcutaneously in the abdomen, thigh, or upper arm, and maintain consistent timing each week.
- It should be used alongside diet and exercise for optimal results.
- Those with a history of pancreatitis, medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2 should avoid this medication.
Comparison with Other Medications
- A recent meta-analysis found that 15 mg weekly of tirzepatide was associated with greater weight loss compared with 2.4 mg weekly of subcutaneous semaglutide and 3 mg daily of subcutaneous liraglutide 1.
- However, a systematic review and network meta-analysis found that SGLT2 inhibitors and GLP1 agonists, but not tirzepatide, reduce all-cause mortality and MACE compared with usual care 2.
Recommendations
- Mounjaro should be considered as a first-line treatment for type 2 diabetes management and weight loss, due to its high efficacy and safety profile.
- Patients should be closely monitored for potential side effects and adjusted to the optimal dose based on response and tolerability.
- Lifestyle modifications, including diet and exercise, should be implemented alongside Mounjaro treatment for optimal results.
From the FDA Drug Label
MOUNJARO is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. The main use of Mounjaro is to improve glycemic control in adults with type 2 diabetes mellitus.
- It is used as an adjunct to diet and exercise.
- Mounjaro is not indicated for use in patients with type 1 diabetes mellitus 3.
From the Research
Overview of Mounjaro
- Mounjaro, also known as tirzepatide, is a dual incretin agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors 4.
- It is approved for use as an adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus (T2DM) in several countries, including the USA, EU, and Japan 4.
Efficacy of Mounjaro
- Tirzepatide has been shown to be superior to GLP-1 receptor agonists, such as dulaglutide and semaglutide, in terms of glycaemic control and weight loss in adults with inadequately controlled T2DM 4, 5.
- In the SURPASS trials, once-weekly subcutaneous tirzepatide was associated with significant reductions in HbA1c and body weight compared to placebo, basal insulin, and GLP-1 analogues 6.
- A systematic review and meta-analysis found that tirzepatide was more efficacious in reducing HbA1c and body weight compared to placebo, GLP-1 RAs, and basal insulin regimens 7.
Safety Profile of Mounjaro
- Tirzepatide was generally well tolerated, with a safety profile consistent with that of GLP-1 RAs 4.
- The most common adverse events associated with tirzepatide were gastrointestinal events, including nausea, diarrhea, decreased appetite, and vomiting 4, 5, 7.
- Tirzepatide was associated with a low risk of clinically significant or severe hypoglycaemia and no increased risk of major adverse cardiovascular events 4.
- The incidence of hypoglycaemia with tirzepatide was similar to that of placebo and lower than that of basal insulin 7.