Dulaglutide

Eli Lilly’s Trulicity links two GLP-1 analog chains to an IgG4 Fc antibody fragment, creating a large molecule suitable for weekly subcutaneous delivery. Dulaglutide is not Lyxumia, which is a different medicine.

GLP-1 receptor activation increases insulin secretion mainly when glucose is high, reducing hypoglycemia risk when used alone. It also lowers glucagon, slows gastric emptying and influences appetite. The Fc fragment extends circulation to about five days. Trial HbA1c reductions were often around 1.5 percentage points, while REWIND reported about a 12% relative reduction in major cardiovascular events in its diabetes population.

FDA approval began with adult type 2 diabetes in 2014. In 2020, the label added major-cardiovascular-event risk reduction for adults with type 2 diabetes and established cardiovascular disease or multiple risk factors. Glycemic use expanded in 2022 to children aged ten and older. Trulicity remains marketed; it does not have an obesity indication.

It is prescribed with diet and exercise for glycemic control in adults and children aged at least ten with type 2 diabetes, and for the specified adult cardiovascular indication. It does not treat type 1 diabetes. Personal/family medullary thyroid carcinoma, MEN2 and serious product hypersensitivity are contraindications.

Common reactions include nausea, diarrhea, vomiting, abdominal pain, reduced appetite and fatigue, often most noticeable during escalation. The boxed thyroid C-cell warning derives from rodent tumors; human relevance is unknown.

Other important risks include pancreatitis, gallbladder disease or stones, dehydration-related acute kidney injury, hypoglycemia with insulin or sulfonylureas, worsening diabetic retinopathy, serious allergy, severe gastrointestinal effects and aspiration around anesthesia. Use in severe gastroparesis is not recommended.

REWIND randomized 9,901 adults aged at least 50 with type 2 diabetes and prior cardiovascular events or risk factors to dulaglutide 1.5 mg weekly or placebo. Over median 5.4 years, cardiovascular death/nonfatal heart attack/nonfatal stroke occurred in 12.0% versus 13.4%: HR 0.88, 95% CI 0.79–0.99. This does not establish benefit in people without diabetes.

AWARD-11 enrolled 1,842 adults inadequately controlled on metformin. At 36 weeks, treatment-regimen weight changes were −4.6 kg with 4.5 mg and −3.0 kg with 1.5 mg. HbA1c was primary and weight secondary; the analysis included discontinuation or rescue treatment. These averages do not establish a universal 5–8% weight loss or equivalence to another GLP-1 medicine.

The adult label starts at 0.75 mg weekly and permits escalation after at least four weeks when needed, to a maximum 4.5 mg. Pediatric maximum is 1.5 mg. A missed dose requires at least 72 hours before the next scheduled dose; otherwise it is skipped.