From the Guidelines
Trulicity (dulaglutide) is a preferred medication over Januvia (sitagliptin) for patients with type 2 diabetes and cardiovascular disease, due to its proven benefits in reducing cardiovascular events and mortality, as demonstrated in the REWIND trial 1. Trulicity is a once-weekly injectable GLP-1 receptor agonist that helps lower blood sugar by stimulating insulin release, slowing stomach emptying, and reducing appetite. Januvia is a daily oral DPP-4 inhibitor that works by preventing the breakdown of incretin hormones, which helps increase insulin production and decrease glucagon levels. These medications can sometimes be prescribed together as part of a comprehensive diabetes management plan, especially when one medication alone doesn't provide adequate blood sugar control. Common side effects of Trulicity include nausea, vomiting, and diarrhea, while Januvia typically has fewer gastrointestinal side effects but may cause upper respiratory infections or headaches. The 2019 ESC guidelines recommend the use of dulaglutide, along with other GLP-1 receptor agonists, in patients with type 2 diabetes and cardiovascular disease to reduce cardiovascular events 1. Additionally, the 2023 standards of care in diabetes highlight the importance of GLP-1 receptor agonists, such as dulaglutide, in reducing cardiovascular risk in patients with type 2 diabetes 1. Any decision to start, combine, or switch between these medications should be made in consultation with a healthcare provider who can consider your specific health needs, current blood sugar control, and other medications you may be taking. Key considerations include the patient's cardiovascular risk profile, as well as potential side effects and interactions with other medications, as outlined in the 2018 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes 1.
From the FDA Drug Label
At the 26-week placebo-controlled time point, the HbA1c change was 0.1%, -1.0%, -1.2%, and -0.6% for placebo, TRULICITY 0.75 mg, TRULICITY 1. 5 mg, and sitagliptin, respectively. The percentage of patients who achieved HbA1c <7.0% was 22%, 56%, 62% and 39% for placebo, TRULICITY 0.75 mg, TRULICITY 1.5 mg, and sitagliptin, respectively. Treatment with TRULICITY 0.75 mg and 1. 5 mg once weekly resulted in a statistically significant reduction in HbA1c compared to placebo (at 26 weeks) and compared to sitagliptin (at 26 and 52 weeks), all in combination with metformin.
Comparison of Trulicity and Januvia (Sitagliptin)
- Trulicity 0.75 mg and 1.5 mg resulted in a statistically significant reduction in HbA1c compared to sitagliptin at 26 and 52 weeks.
- The percentage of patients who achieved HbA1c <7.0% was higher with Trulicity (56% and 62% for 0.75 mg and 1.5 mg, respectively) compared to sitagliptin (39%).
- Trulicity also resulted in a greater reduction in body weight and fasting serum glucose compared to sitagliptin 2.
From the Research
Trulicity and Januvia Comparison
- Trulicity (dulaglutide) is a once-weekly subcutaneously administered glucagon-like peptide-1 (GLP-1) receptor agonist, approved for the treatment of adults with type 2 diabetes (T2DM) 3, 4.
- Januvia (sitagliptin) is an oral dipeptidyl peptidase-4 (DPP-4) inhibitor, also used to treat T2DM.
- In clinical trials, dulaglutide has been shown to be more effective than sitagliptin in improving glycemic control, with a greater proportion of patients reaching glycated hemoglobin A1c (HbA1c) targets 5, 6.
Efficacy and Safety
- Dulaglutide has been demonstrated to be effective in reducing HbA1c levels, with a significant proportion of patients achieving HbA1c targets of <7.0% and ≤6.5% 7, 6.
- The safety profile of dulaglutide is similar to other GLP-1 receptor agonists, with gastrointestinal symptoms (e.g., nausea, vomiting, and diarrhea) being the most frequently reported adverse events 3, 5.
- Dulaglutide has been associated with weight loss or attenuation of weight gain, and low rates of hypoglycemia when used alone or with non-insulin-secretagogue therapy 4, 6.
Clinical Trial Data
- The AWARD phase 3 clinical trial program has demonstrated the efficacy and safety of dulaglutide in the treatment of T2DM, with once weekly dulaglutide 1.5 mg being superior to active comparators (e.g., exenatide, insulin glargine, metformin, and sitagliptin) in five of six studies 6.
- Dulaglutide 1.5 mg was non-inferior to liraglutide in AWARD-6, and once weekly dulaglutide 0.75 mg was evaluated in five trials, demonstrating superiority to active comparators in four of five AWARD studies 6.