GLP-1 Receptor-Agonist Agents: How to Integrate into Current Diabetes Treatment

MARCH 25, 2017
Jennifer Barrett
SAN FRANCISCO -- Two new fixed-dose basal/GLP-1 receptor-agonist (RA) agents, Soliqua 100/33 (Sanofi) and Xultophy 100/3.6 (Novo Nordisk), were approved by the FDA in November 2016.  
 
Soliqua 100/33, a combination of U100/mL glargine and 33 mcg/mL lixisenatide (iGlarLixi), was approved for use in patients with type 2 diabetes receiving <60 units daily of basal insulin or lixisenatide.
 
Xultophy, a combination of U100/mL insulin degludec and 3.6 mg/mL liraglutide (iDegLira), is indicated for patients inadequately controlled on <50 units of basal or ≤1.8 mg of liraglutide.
 
During a Pharmacy Times Continuing Education-led event at the American Pharmacists Association’s 2017 Annual Meeting & Exhibition held this week, Jennifer Goldman, PharmD, and Dhiren Patel, PharmD, both of the Massachusetts College of Pharmacy and Health Sciences, provided an overview on integrating these new GLP-1 RA therapies into current treatment strategies for patients with type 2 diabetes.
 
Dr. Goldman noted that key counseling points to consider include:
 
iGlarLixi
 
  • For patients inadequately controlled on <30 units of basal insulin or lixisenatide, the starting dose should be 15 units/5 mcg iGlarLixi daily.
  • Patients inadequately controlled on less than 30-60 units of basal insulin or on lixisenatide the starting dose should be 30 units/10 mcg iGlarLixi daily.
  • Doses range from 15-60 units in a single injection.
  • Give once a day within 1 hour of first meal.
  • Titrate dose by 2-4 units weekly.
  • Max dose is 60 units of insulin glargine and 20 mcg of lixisenatide.
 
iDegLira
 
  • Each dose step – 1 unit insulin degludec + 0.036 mg liraglutide (10 units/0.36 mg): 100 u/mL insulin degludec, 3.6 mg/mL liraglutide
  • For patients inadequately controlled on <50 units of basal or ≤1.8 mg of liraglutide.
  • Recommended starting dose is 16 units/0.58 mg
  • Administer daily at the same time each day with or without food.
  • Max daily dose is 50 units/1.8 mg iDegLira.
 
For both treatments, patients should not remove contents from pens with syringe or share pens. Missed doses can be taken the next day at the regularly scheduled time.
 
In comparison with basal bolus insulin therapy, GLP-1 RAs exhibit noninferiority, reduced injection burden, less weight gain, and less incidence of hypoglycemia. However, patients may experience more gastrointestinal adverse events, Dr. Patel said.
 
 
References
 
Diamant M. Diabetes Care. 2014;37(10):2763-2773. 
Rosenstock J. Diabetes Care. 2014;37(8):2317-2325. 
Mathieu C. Diabetes Obes Metab. 2014;16(7):636-644.
Roy-Duval C. Diabetologia. 2015;58(suppl 1):S39.
Patel D, Goldman J. Managing Diabetes with Insulin/GLP-1 Receptor Agonist Combinations. Presented at: American Pharmacists Association 2017 Annual Meeting & Exposition. Mar. 24-27, 2017. San Francisco.
Soliqua [package insert]. Bridgewater, NJ: sanofi-aventis U.S. LLC; 2016 https://www.soliqua100-33.com/. Accessed February 6, 2017. 
Xultophy [package insert]. Bagsvaerd, Denmark: Novo Nordisk A/S; 2016. http://www.novo-pi.com/xultophy10036.pdf. Accessed February 6, 2017.
 
 

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