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Switching between GLP-1 receptor agonists in clinical practice: Expert consensus and practical guidance
Akshay B Jain1, Amar Ali2, Juan J Gorgojo Martínez3
1University of British Columbia, Surrey, BC, Canada.
International Journal of Clinical Practice
|September 25, 2020
Summary
Switching between glucagon-like peptide-1 receptor agonists (GLP-1RAs) can benefit patients with type 2 diabetes by improving glycemic control and weight loss. This expert consensus provides guidance on managing transitions to optimize patient outcomes.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Diseases
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are established treatments for type 2 diabetes (T2D).
- Variations in pharmacokinetics, dosing, and clinical effects, including cardiovascular outcomes, suggest potential benefits of switching between GLP-1RAs.
- Current clinical guidance on switching GLP-1RAs is limited, necessitating expert consensus.
Purpose of the Study:
- To provide a clinical perspective and consensus on the benefits of switching between GLP-1RAs.
- To identify triggers for switching GLP-1RAs in clinical practice.
- To outline best practices for managing GLP-1RA switches.
Main Methods:
- A literature search was conducted.
- Perspectives from 10 healthcare professionals experienced in switching T2D patients to once-weekly (OW) semaglutide from other GLP-1RAs were collated.
Main Results:
- Medical triggers for switching include unmet HbA1c targets, desire for additional weight loss, poor adherence, increased cardiovascular risk, and adverse effects.
- Non-medical triggers include patient preference, cost, formulary changes, and insurance mandates.
- An individualized approach to switching is recommended, considering reimbursement, prior treatment, patient experience, concomitant therapies, and clinical characteristics. Slow up-titration and dietary advice can mitigate transient gastrointestinal adverse effects.
Conclusions:
- Switching between GLP-1RAs, exemplified by OW semaglutide, offers clinical advantages.
- Switching may postpone the need for intensified diabetes treatment.
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