What is the use of Trulicity (Dulaglutide)?

From the Guidelines

Trulicity (dulaglutide) should be initiated at a dose of 0.75 mg subcutaneously per week and titrated as tolerated to 1.5 mg or maximally tolerated dose based on prescribing information, as it has demonstrated cardiovascular benefit in patients with type 2 diabetes.

Key Points

• Trulicity is a once-weekly injectable medication used to treat type 2 diabetes, belonging to the GLP-1 receptor agonist class.
• The medication comes in pre-filled pens with doses ranging from 0.75 mg to 4.5 mg, with typical starting doses at 0.75 mg weekly and potential increases to 1.5 mg after four weeks if needed for better blood sugar control.
• Trulicity works by stimulating insulin release when blood sugar is high, slowing stomach emptying, and reducing appetite, which helps lower blood glucose levels and may contribute to weight loss.
• Common side effects include nausea, vomiting, and diarrhea, which often improve over time, as reported in studies such as 1.
• The medication should be injected subcutaneously in the abdomen, thigh, or upper arm, and can be administered without regard to meals.
• Patients should store unopened pens in the refrigerator and can keep the pen in use at room temperature for up to 14 days.

Important Considerations

• Dose modifications: Up-titrate slowly to reduce nausea and discontinue if pancreatitis is suspected and do not restart if pancreatitis is confirmed, as indicated in 1.
• Contraindications: History of serious hypersensitivity reaction to drug, pregnancy or breast feeding, severe renal impairment or end-stage renal failure, personal or family history of medullary thyroid cancer, and personal or family history of MEN2.
• Cautions: Hypoglycemia risk increased with insulin, sulfonylureas, or glinides, may delay gastric emptying, and not recommended in patients with clinically meaningful gastroparesis.
• Adverse effects to monitor: Nausea, vomiting, diarrhea, headache, weakness, or dizziness, hypoglycemia when given with insulin, sulfonylureas, or glinides, weight loss, and injection site reactions, as outlined in 1 and 1.

From the FDA Drug Label

TRULICITY is an injectable prescription medicine that is used: along with diet and exercise to improve blood sugar (glucose) in adults and children 10 years of age and older with type 2 diabetes mellitus. to reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with type 2 diabetes mellitus with known heart disease or multiple cardiovascular risk factors The main use of Trulicity is to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus, and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors 2.

• Key Indications:
  • Improve blood sugar control in adults and children 10 years and older with type 2 diabetes
  • Reduce risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease or multiple risk factors
• Limitations of Use:
  • Not for treatment of type 1 diabetes mellitus
  • Not recommended in patients with severe gastrointestinal disease, including severe gastroparesis
  • Has not been studied in patients with a history of pancreatitis 2.

From the Research

Overview of Trulicity

• Trulicity, also known as dulaglutide, is a once-weekly subcutaneously administered glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of adults with type 2 diabetes (T2D) 3, 4.
• It is approved in numerous countries as an adjunct to diet and exercise for the treatment of T2D.

Efficacy of Trulicity

• Dulaglutide has been shown to be effective in improving glycemic control in patients with T2D, with significant reductions in glycated hemoglobin (HbA1c) levels compared to other treatments such as metformin, sitagliptin, and exenatide 3, 5.
• It has also been shown to be effective in reducing body weight, with consistent reductions in body weight observed in clinical trials 3, 6.
• In the REWIND CV outcomes trial, dulaglutide was associated with a significant reduction in the risk of major adverse cardiac events (MACE) in patients with T2D with or without cardiovascular disease 4.

Safety and Tolerability of Trulicity

• Dulaglutide has been generally well tolerated in clinical trials, with a low inherent risk of hypoglycemia 3, 4.
• The most frequently reported adverse events in clinical trials were gastrointestinal-related, such as nausea, vomiting, and diarrhea 3, 6.
• Dulaglutide has also been shown to be safe and effective in high-risk patients, including obese and elderly patients, and those with stage 3 or 4 chronic kidney disease (CKD) and/or cardiovascular (CV) disease 4.

Additional Uses of Trulicity

• Dulaglutide has been investigated as a potential treatment for binge eating disorder (BED) in patients with type 2 diabetes and obesity, with promising results in a case report 7.
• Further research is needed to evaluate the long-term effectiveness of dulaglutide in the management of BED and to determine the optimal duration and dose.