During the first quarter of this year, CCA’s Clinical Pharmacy department conducted a Population Health Project that focused on identifying duplicate diabetic medications, specifically the co-prescription of DPP4 inhibitors and GLP-1 agonists. The American Diabetic Association recommends against the simultaneous use of both drug classes due to the increased risk of side effects such as gastrointestinal disturbances and pancreatitis.
This duplication is an instance of polypharmacy and incurs extra pharmacy costs without therapeutic benefit. We strongly urge all prescribers to review members receiving this duplication and provide the appropriate therapy for your patient.
GLP-1 Agonists include Dulaglutide (Trulicity®), Exenatide (Byetta®, Bydureon®), Liraglutide (Victoza®), Lixisenatide (Adlyxin®), Semaglutide (Ozempic®, Rybelsus®). DPP-4 inhibitors include Alogliptin (Nesina®), Linagliptin (Tradjenta®), Saxagliptin (Onglyza®), Sitagliptin (Januvia®). If your patient is taking a DPP-4 inhibitor and GLP-1 agonist concurrently, please take one of the following actions:
- Preferred Option: Discontinue DPP-4 inhibitor and Continue GLP-1 agonist.
GLP-1 agonists result in more potent A1c reduction, are associated with weight loss (DPP-4 inhibitors are weight neutral) and some have been demonstrated decreased risk of negative cardiovascular outcomes (dulaglutide, liraglutide, and SQ semaglutide), therefore are often superior for the treatment of Type 2 Diabetes.
- Alternative Option: Continue DPP-4 inhibitor and Discontinue GLP-1 agonist.
A taper is not needed when discontinuing either medication.
References:
- Baptist Gallwitz, Clinical Use of DPP-4 Inhibitors, Frontiers in Endocrinology, 10.3389/fendo.2019.00389, 10, (2019).
- Davies MJ, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) andthe European Association for the Study of Diabetes (EASD). Diabetes Care. 2018 Dec;41(12):2669-2701.
- Nuha A. ElSayed, et al; on behalf of the American Diabetes Association, 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care inDiabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S140–S157.
- PL detail-document. Combining a GLP-1 agonist and a DPP-4 inhibitor for type 2 diabetes. Pharmacist’s Letter/Prescriber’s Letter. August 2012.