Equivalent Dose Conversion: Dulaglutide to Liraglutide
There is no established equivalent dose conversion between dulaglutide 1.5 mg weekly and liraglutide, but the closest comparable dose is liraglutide 1.8 mg daily based on head-to-head trial data showing similar glycemic efficacy.
Direct Comparison Evidence
The AWARD-6 trial provides the most robust head-to-head comparison between these two GLP-1 receptor agonists 1:
- Dulaglutide 1.5 mg once weekly achieved a mean HbA1c reduction of -1.42% (SE 0.05)
- Liraglutide 1.8 mg once daily achieved a mean HbA1c reduction of -1.36% (SE 0.05)
- The difference was statistically non-inferior, with similar safety profiles including comparable rates of nausea (20% vs 18%), diarrhea (12% vs 12%), and hypoglycemia 1
Real-World Effectiveness Data
A 2020 real-world observational study and meta-analysis found that dulaglutide actually demonstrated slightly superior HbA1c reduction compared to liraglutide (-0.24% greater reduction, p=0.003) 2. This difference may be attributed to:
- Adherence advantages: Once-weekly dosing of dulaglutide versus once-daily liraglutide
- Dose optimization: Liraglutide requires titration from 0.6 mg to 1.2 mg to 1.8 mg, and real-world data suggests many patients remain on suboptimal doses 2
Practical Conversion Approach
When switching from dulaglutide 1.5 mg weekly to liraglutide:
- Target dose: Liraglutide 1.8 mg daily (maximum approved dose for diabetes)
- Titration schedule: Start liraglutide at 0.6 mg daily for 1 week, then increase to 1.2 mg daily for at least 1 week, then advance to 1.8 mg daily 1
- Timing: Discontinue dulaglutide and begin liraglutide titration immediately, as dulaglutide has a half-life of approximately 5 days
- Monitoring: Assess glycemic control 4-6 weeks after reaching liraglutide 1.8 mg daily
Important Caveats
Gastrointestinal tolerability may differ between agents despite similar overall adverse event rates 1:
- The titration requirement for liraglutide may reduce acute GI symptoms compared to direct initiation
- If the patient experienced significant nausea with dulaglutide, consider slower liraglutide titration (extending each dose level to 2 weeks)
Cardiovascular and renal benefits are established for both agents in patients with type 2 diabetes and chronic kidney disease, with no dose adjustment required for either medication across all stages of CKD (though exenatide should be avoided in severe renal impairment) 3.
Weight loss effects are comparable between dulaglutide 1.5 mg weekly and liraglutide 1.8 mg daily, with both producing approximately 2.5-3 kg weight reduction over 26-52 weeks 1, 2.