From the Guidelines
To convert from Xultophy to Soliqua, patients can start Soliqua at 15 units (15 units insulin glargine/5 mcg lixisenatide) if the previous total daily insulin dose was less than 30 units, or 30 units (30 units insulin glargine/10 mcg lixisenatide) if the previous insulin dose was 30-60 units, as recommended by the most recent guidelines 1. When converting from Xultophy to Soliqua, it is essential to consider the different components of each medication, as Xultophy contains insulin degludec and liraglutide, while Soliqua contains insulin glargine and lixisenatide.
- The conversion should occur on the day following the last dose of Xultophy.
- Close monitoring of blood glucose is crucial during the transition period, with dose adjustments made every 3-7 days based on fasting glucose levels.
- The maximum daily dose of Soliqua is 60 units.
- Patients should be informed about potential differences in side effects between the medications, particularly gastrointestinal symptoms that may occur with the GLP-1 component. The conversion requires careful consideration because these combination products contain different GLP-1 receptor agonists with varying potencies and different basal insulins with different pharmacokinetic profiles, as outlined in the 2022 standards of medical care in diabetes 1.
- The American Diabetes Association recommends that metformin therapy should be maintained when initiating combination injectable therapy, while sulfonylureas and DPP-4 inhibitors are typically weaned or discontinued 1.
- In individuals with suboptimal blood glucose control, especially those requiring large insulin doses, adjunctive use of a thiazolidinedione or an SGLT2 inhibitor may help to improve control and reduce the amount of insulin needed, though potential side effects should be considered 1.
From the Research
Conversion from Xultophy to Soliqua
- Xultophy is a fixed-ratio combination of insulin degludec and liraglutide, while Soliqua is a fixed-ratio combination of insulin glargine and lixisenatide 2, 3.
- There is no direct evidence on how to convert from Xultophy to Soliqua, but studies have compared the efficacy and safety of these two combinations in patients with type 2 diabetes 4, 5, 6.
- A network meta-analysis found that both combinations were more efficacious than their individual components, but there was no significant difference between the two combinations in terms of glycated hemoglobin (A1C) level attained 5.
- Another study found that the time in range (TIR) and time below range (TBR) level 1 were not significantly different between the two groups, and both groups showed significant positive correlations between the C-peptide index and TIR 6.
- The conversion from Xultophy to Soliqua may require adjustments to the dose and regimen, and should be done under the guidance of a healthcare professional 4, 5, 6.
- The choice between Xultophy and Soliqua may depend on individual patient factors, such as the presence of renal or hepatic impairment, and the risk of hypoglycemia or other adverse events 2, 3.