What is the role of Dulaglutide (generic name) in the management of obesity?

From the Guidelines

Dulaglutide is effective for weight loss in obesity, though it's primarily FDA-approved for type 2 diabetes management, and should be considered as an option for obesity treatment, particularly when used in conjunction with lifestyle modifications, as it has been shown to reduce weight and improve weight-related comorbidities, as seen in studies such as 1 and 1.

Key Points to Consider

• For obesity treatment, dulaglutide is typically prescribed off-label at doses starting at 0.75mg once weekly by subcutaneous injection, potentially increasing to 1.5mg, 3mg, or 4.5mg weekly based on response and tolerability, as suggested by 1.
• Treatment duration is generally long-term, as weight regain commonly occurs upon discontinuation, highlighting the importance of sustained lifestyle modifications and potentially long-term medication use, as noted in 1 and 1.
• Patients should combine dulaglutide with lifestyle modifications including caloric restriction and increased physical activity for optimal results, as emphasized by 1 and 1.
• Dulaglutide works by mimicking GLP-1 (glucagon-like peptide-1), which reduces appetite, slows gastric emptying, and increases feelings of fullness, as explained in 1 and 1.
• Clinical trials show weight loss of approximately 2-5kg over 6-12 months with dulaglutide, although more significant weight loss has been observed with other GLP-1 receptor agonists like semaglutide, as reported in 1.
• Common side effects include nausea, vomiting, diarrhea, and constipation, which often improve over time, as mentioned in 1 and 1.
• Dulaglutide should be avoided in patients with personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, and used cautiously in those with pancreatitis history, as cautioned by 1 and 1.

Comparison with Other Treatments

• Other GLP-1 receptor agonists like semaglutide and liraglutide have also been shown to be effective for weight loss in obesity, with semaglutide demonstrating more significant weight loss in some studies, as seen in 1.
• Phentermine-topiramate and naltrexone-bupropion are other pharmacological options for obesity treatment, but they may have different side effect profiles and efficacy compared to dulaglutide, as discussed in 1 and 1.

Clinical Decision Making

• The choice of dulaglutide for obesity treatment should be based on individual patient factors, including comorbidities, patient preferences, and potential side effects, as suggested by 1 and 1.
• Healthcare providers should consider the latest clinical guidelines and evidence when making decisions about pharmacological interventions for obesity, including the use of dulaglutide, as emphasized by 1, 1, and 1.

From the Research

Role of Dulaglutide in Obesity Management

Dulaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to play a significant role in the management of obesity, particularly in patients with type 2 diabetes mellitus (T2DM) 2, 3, 4, 5, 6. The key aspects of dulaglutide's role in obesity management include:

• Weight Loss: Dulaglutide has been consistently associated with significant weight loss in patients with T2DM 2, 3, 5, 6. A systematic review and meta-analysis of randomized controlled trials found that subcutaneous dulaglutide administration resulted in notable decreases in body weight, body mass index (BMI), and waist circumference (WC) 2.
• Dose-Response Relationship: The efficacy of dulaglutide in promoting weight loss and improving glycemic control has been shown to be dose-dependent 4, 6. Higher doses of dulaglutide (3.0 and 4.5 mg) have been found to be superior to the approved dose of 1.5 mg in reducing HbA1c and body weight 6.
• Comparison with Other GLP-1 Receptor Agonists: Dulaglutide has been compared with other GLP-1 receptor agonists, such as semaglutide and liraglutide, in terms of its efficacy in reducing epicardial fat thickness and promoting weight loss 4. The results suggest that dulaglutide is effective in reducing epicardial fat thickness and promoting weight loss, although the magnitude of these effects may vary depending on the dose and duration of treatment.
• Safety Profile: The safety profile of dulaglutide has been found to be consistent with that of other GLP-1 receptor agonists, with gastrointestinal events being the most common adverse effects 3, 5, 6. The higher doses of dulaglutide (3.0 and 4.5 mg) have been found to have a safety profile consistent with the established safety profile for dulaglutide 6.

Some key findings from the studies include:

• Subcutaneous dulaglutide administration resulted in significant decreases in body weight, BMI, and WC in patients with T2DM 2.
• The decrease in body weight and WC was influenced by the dose and duration of dulaglutide administration 2.
• Dulaglutide was found to be effective in reducing epicardial fat thickness in patients with T2DM and obesity 4.
• The higher doses of dulaglutide (3.0 and 4.5 mg) were found to be superior to the approved dose of 1.5 mg in reducing HbA1c and body weight 6.