September 18th, 2014
FDA Approves New Once-Weekly GLP-1 Receptor Agonist for Type 2 Diabetes
Larry Husten, PHD
The FDA said today that it had approved dulaglutide, Lilly’s once-weekly injection to control blood sugar in adults with type 2 diabetes. The drug will be marketed under the brand name of Trulicity.
The FDA said that the safety and efficacy of dulaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, had been studied in 3,342 type 2 diabetics. The drug can be given as monotherapy or in combination with other diabetes drugs including metformin, sulfonylurea, thiazolidinediones, and prandial insulin. It is not indicated for use in type 1 diabetics, in people with diabetic ketoacidosis, or in people with severe intestinal problems. It should not be used as initial therapy in diabetics who cannot be managed with diet and exercise.
The drug label will contain a boxed warning that in rodents dulaglutide was linked to tumors of the thyroid gland (thyroid C-cell tumors). The FDA says that it is unknown whether the drug can cause these tumors in humans, including a type of thyroid cancer called medullary thyroid carcinoma (MTC). Dulaglutide should not be used in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2, which may predispose them to MTC.
The most common side effects found in people taking dulaglutide were nausea, diarrhea, vomiting, abdominal pain, and decreased appetite.
The FDA said that it would require Lilly to perform a number of post-marketing studies, including a cardiovascular outcomes trial, a trial in pediatric patients, and a long-term (15-year) registry to identify any increase in the rate of MTC.
Lilly will also be required to implement a Risk Evaluation and Mitigation Strategy (REMS), in which the company will inform physicians and other healthcare professionals about the serious risks linked to the drug.
NEJM Journal Watch — Recent Cardiology Articles- Anticoagulation in Patients with Cancer-Associated Pulmonary Embolism: How Long is Long Enough?
- Spironolactone Use After Percutaneous Intervention for Acute Myocardial Infarction
- CRISPR/Cas9 Gene Editing for Transthyretin Cardiomyopathy
- Does Colchicine Reduce Cardiac Events After Myocardial Infarction?
- First-Line Therapy for Ventricular Tachycardia After MI: What's the Best Approach?