Mode of administration of dulaglutide: implications for treatment adherence

Abstract

BackgroundMedication complexity/burden can be associated with nonadherence in patients with type 2 diabetes mellitus (T2DM). Patients’ satisfaction with their treatment is an important consideration for physicians. Strategies like using longer acting efficacious agents with less frequent dosing may help adherence.ObjectiveTo explore the mode of administration of dulaglutide and its implications for treatment adherence in T2DM.MethodsPubMed search using the term “Dulaglutide” through October 31, 2015 was conducted. Published articles, press releases, and abstracts presented at national/international meetings were considered.Results/conclusionDulaglutide is a once-weekly glucagon like peptide-1 analog with a low intraindividual variability. Phase III trials demonstrated significant improvements in glycemia and weight, with a low hypoglycemia risk similar to liraglutide/exenatide, but with substantially fewer injections. A significant improvement was observed in the total Diabetes Treatment Satisfaction Questionnaire score, Impact of Weight on Self-Perception, and perceived frequency of hyperglycemia with dulaglutide when compared with placebo, exenatide, liraglutide, or metformin. Treatment satisfaction scores showed an improvement with dulaglutide (34%–39%) when compared with exenatide (31%). A positive experience with a high initial (97.2%) and final (99.1%) injection success rate along with a significant reduction in patients’ fear of self-injecting, as measured by the modified self-injecting subscale of the Diabetes Fear of Injecting and Self-Testing Questionnaire and Medication Delivery Device Assessment Battery, was found. Its acceptance was high (>96%) among a variety of patients including patients who fear injections and injection-naïve users. Dulaglutide is available as a single-dose automatic self-injecting device, which has a low volume, does not need reconstitution, and avoids patient handling of the needle. Dose adjustment based on weight, sex, age, race, ethnicity, or injection-site is not necessary. In chronic diseases like diabetes where patients need lifelong medications, the efficacy, safety, and convenience of a once-weekly, easy-to-use, self-injecting device should encourage patient adherence to dulaglutide therapy.

<p>Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice</p>

“…Adherence has been found to be higher for dulaglutide and lower for exeOW, 40–44 and this might be related to a simpler and easier device used for injection. 45 Confirming this hypothesis, sensitivity “as-treated” analyses focused only on those subjects with confirmed prescription of treatments at follow-up visits (considered as subjects with higher adherence) shows equivalent effectiveness of dulaglutide and exeOW, 37 as reported in previous network-meta-analyses of RCTs. 33 , 34 …”

“…Adherence has been found to be higher for dulaglutide and lower for exeOW, [40][41][42][43][44] and this might be related to a simpler and easier device used for injection. 45 Confirming this hypothesis, sensitivity "as-treated" analyses focused only on those subjects with confirmed prescription of treatments at followup visits (considered as subjects with higher adherence) -Overall Adherence in RWS is lower than RCTs 37,38,46 -Adherence specifically influenced by compound/devices (eg, dulaglutide>exeOW) [40][41][42][43][44][45][46] -Different clinical characteristics between patients enrolled in RCTs vs those treated with GLP-1RAs in RWS (see Table 2) Dula 1.5 mg = Lira 1.8 mg 29 Dula > Lira 37 Dula = ExeOW (from NWMA) 33,34 Dula > ExeOW 35,37 Sema (0.5 or 1.0 mg) > Dula 1.5 mg 29 No RWS Dula = ExeOW (from NWMA) 33,34 Dula > ExeOW 35,37 Sema (0.5 or 1.0 mg) > Dula 1.5 mg 29 No RWS Note: The symbol ">" or "<" are used to describe significant higher or lower efficacy (RCTs) or effectiveness (RWS) between compounds. Abbreviations: Legend Lira, liraglutide; Sema, semaglutide; ExeOW, exenatide-once-weekly; ExeBID, exenatide-bis-in-die; NWMA, network meta-analyses.…”

Treatment patterns in patients with type 2 diabetes mellitus treated with glucagon‐like peptide‐1 receptor agonists: Higher adherence and persistence with dulaglutide compared with once‐weekly exenatide and liraglutide

“…Higher adherence and persistence with dulaglutide over liraglutide may be related to its simplified dosing—once weekly for dulaglutide vs once daily for liraglutide . Dulaglutide's ready‐to‐use single‐dose pen that does not require handling of the needle or reconstitution, vs the exenatide once‐weekly pen or the exenatide once‐weekly vial/syringe kit that requires reconstitution and delivery by a 23‐gauge needle, could have been another factor in the greater adherence and persistence rates seen with dulaglutide.…”

ANDREW: A Multicenter, Prospective, Observational Study in Patients with Type 2 Diabetes on Persistent Treatment with Dulaglutide

“…Dulaglutide is a long-acting glucagon-like peptide1-receptor agonist (GLP-1RA) that is injected subcutaneously once weekly in patients with type 2 diabetes (T2D) whose blood sugar level is not well controlled with standard treatments [ 1 ]. The peakless pharmacological profile of dulaglutide allows an effective metabolic activity between two injections, with steady-state reached after the second week of therapy [ 1 ].…”

“…Dulaglutide is a long-acting glucagon-like peptide1-receptor agonist (GLP-1RA) that is injected subcutaneously once weekly in patients with type 2 diabetes (T2D) whose blood sugar level is not well controlled with standard treatments [ 1 ]. The peakless pharmacological profile of dulaglutide allows an effective metabolic activity between two injections, with steady-state reached after the second week of therapy [ 1 ]. Dulaglutide became available in Italy in April 2016 with an AIFA (Italian Medicine Agency) limitation as “add-on” to either metformin, sulphonylureas (SUs), pioglitazone or basal insulin, or in addition to metformin + SUs or metformin + pioglitazone or metformin + basal insulin.…”