What is Xultrophy in medical terms?

Xultophy: Fixed-Ratio Combination Insulin Degludec/Liraglutide

Xultophy® (IDegLira) is a fixed-ratio combination of ultra-long-acting basal insulin degludec and the GLP-1 receptor agonist liraglutide, indicated for adults with type 2 diabetes inadequately controlled on basal insulin or oral antidiabetic medications. 1, 2

Composition and Pharmacology

• Each dose step contains insulin degludec 1 unit and liraglutide 0.036 mg, allowing synchronized titration of both components in a single daily subcutaneous injection 2
• Insulin degludec has an ultra-long half-life of approximately 25 hours, providing continuous insulin coverage with superior pharmacokinetic and pharmacodynamic reproducibility compared to other basal insulins 2
• Liraglutide is a once-daily GLP-1 receptor agonist that has demonstrated cardiovascular and renal protection in patients with type 2 diabetes at high cardiovascular risk 2

Clinical Efficacy

• IDegLira provides significantly greater HbA1c reductions than insulin degludec alone, liraglutide alone, or placebo in insulin-naive patients with inadequately controlled type 2 diabetes 1
• In insulin-experienced patients, IDegLira achieves superior HbA1c improvements compared to equivalent doses of insulin degludec or ongoing insulin glargine therapy 1
• The combination allows patients to reach individualized glycemic targets with lower total daily insulin doses compared to basal insulin regimens alone 2
• Efficacy is maintained for at least 52 weeks based on extension trial data 1

Safety and Tolerability Profile

• IDegLira causes significantly less confirmed hypoglycemia than insulin degludec in insulin-naive patients and less than insulin glargine in insulin-experienced patients 1
• The combination produces less initial nausea than liraglutide monotherapy due to the gradual GLP-1 receptor agonist dose escalation inherent in the titration schedule 1
• IDegLira has a more favorable effect on body weight compared to basal insulin regimens, avoiding the weight gain typically associated with insulin intensification 2
• Gastrointestinal adverse effects are reduced compared to liraglutide alone 2

Dosing and Administration

• Start at 16 dose steps (16 units insulin degludec/0.58 mg liraglutide) once daily, administered subcutaneously 2
• Titrate progressively up to a maximum of 50 dose steps per day (50 units insulin degludec/1.8 mg liraglutide) 2
• The medication is supplied as a prefilled pen device for patient convenience 2

Cost-Effectiveness

• Real-world evidence from the EXTRA study demonstrates that IDegLira is cost-effective or cost-saving compared to multiple daily insulin injections, GLP-1 receptor agonist plus insulin combinations, basal insulin alone, and GLP-1 receptor agonist monotherapy in the Spanish healthcare system 3
• IDegLira reduces the incidence of diabetes-related complications and improves quality-adjusted life expectancy versus comparator injectable regimens 3
• The combination was dominant (cost-saving while improving outcomes) versus GLP-1 receptor agonist combinations with insulin and versus GLP-1 receptor agonist monotherapy 3