From the Guidelines
In Canada, the available GLP-1 receptor agonist medication options include semaglutide (Ozempic, Wegovy, Rybelsus), dulaglutide (Trulicity), liraglutide (Victoza, Saxenda), exenatide (Byetta, Bydureon), and lixisenatide (Adlyxine) 1. These medications work by mimicking the action of the naturally occurring GLP-1 hormone, which stimulates insulin secretion, suppresses glucagon release, slows gastric emptying, and increases satiety. Some key points to consider when prescribing these medications include:
- Semaglutide is available as a once-weekly injection (Ozempic) at doses of 0.25mg, 0.5mg, 1mg, or 2mg, or as a daily oral tablet (Rybelsus) at 3mg, 7mg, or 14mg 1.
- Dulaglutide (Trulicity) is administered as a once-weekly injection at doses of 0.75mg, 1.5mg, 3mg, or 4.5mg 1.
- Liraglutide is available as Victoza for diabetes (1.2mg or 1.8mg daily) or Saxenda for weight management (up to 3mg daily) 1.
- These medications generally require dose titration to minimize gastrointestinal side effects like nausea, vomiting, and diarrhea 1.
- Coverage varies across provincial formularies and private insurance plans, with some medications being more widely covered than others. It's also important to note that GLP-1 receptor agonists have shown cardiovascular and CKD benefits, with liraglutide, semaglutide, albiglutide, and dulaglutide being preferred agents 1. When used with insulin or insulin secretagogues, doses of these drugs may be reduced to avoid hypoglycemia 1. However, in moderate-to-severe CKD (CKD stages G3 and G4), rates of hypoglycemia are reduced by one-half even with concurrent insulin therapy 1.
From the FDA Drug Label
Liraglutide Injection contains liraglutide, an analog of human GLP-1 and acts as a GLP-1 receptor agonist. TRULICITY contains dulaglutide, which is a human GLP-1 receptor agonist with 90% amino acid sequence homology to endogenous human GLP-1 (7-37).
The available GLP-1 receptor agonist medication options in Canada include:
- Liraglutide (Victoza) 2
- Dulaglutide (Trulicity) 3 3 Note that Semaglutide (Ozempic) is not mentioned in the provided drug labels, therefore, its availability in Canada cannot be confirmed based on the given information.
From the Research
GLP-1 Receptor Agonist Medication Options in Canada
The following GLP-1 receptor agonist medications are available in Canada:
- Liraglutide (Victoza) 4, 5, 6
- Dulaglutide (Trulicity) 7, 8
- Semaglutide (Ozempic) 7
- Exenatide (Byetta, Bydureon) 7, 8
- Lixisenatide (Adlyxin) 8
Key Characteristics of GLP-1 Receptor Agonist Medications
- Liraglutide: once-daily subcutaneous injection, starting dose 0.6 mg, increased to 1.2 mg after at least 1 week, and up to 1.8 mg if necessary 4, 5, 6
- Dulaglutide: once-weekly subcutaneous injection, dose 1.5 mg 8
- Semaglutide: once-weekly subcutaneous injection, dose 1.0 mg, or oral formulation, dose 3 mg, 7 mg, or 14 mg 7
- Exenatide: twice-daily subcutaneous injection (Byetta), or once-weekly subcutaneous injection (Bydureon) 7, 8
- Lixisenatide: once-daily subcutaneous injection, dose 20 mcg 8
Treatment Patterns and Persistence
- A retrospective analysis of pharmacy claims data in six countries, including Canada, found that persistence with GLP-1 RA therapy varied by medication, with dulaglutide having the highest persistence rate 8
- The mean average daily dose (ADD) or average weekly dose (AWD) for each medication was generally in line with the recommended label 8