Switching to tirzepatide from GLP-1 RAs shows promise in diabetes treatment, unravels study

The study found that switching from stable GLP-1 receptor agonist treatment to tirzepatide was effective and safe for patients with type 2 diabetes. Patients experienced additional weight reduction and improved glycemic outcomes with an acceptable risk of adverse [gastrointestinal] events during the first 12 weeks.

The findings were presented at an American Association of Clinical Endocrinology meeting and published in Endocrine Practice.

Tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP) and a glucagon-like peptide-1 receptor agonist has garnered attention for its potent glucose-lowering effects and weight management benefits. Serge Jabbour from Thomas Jefferson University in Philadelphia, Pennsylvania, and colleagues aimed to describe the clinical course in terms of body weight, glycemic outcomes, and adverse events during the first 12 weeks following a switch from GLP-1 receptor agonists directly to tirzepatide 5 mg in a prospective study.

It included participants ≥18 years with type 2 diabetes (T2D), body mass index ≥25 kg/m2, glycated hemoglobin (HbA1c) ≥6.5% to ≤9.0%, and were on a stable treatment dose of GLP-1 RAs (semaglutide once-weekly [0.5, 1.0, 2.0 mg], liraglutide every day [1.2, 1.8 mg], or dulaglutide once-weekly [0.75, 1.5, 3.0, and 4.5 mg]) for ≥3 months at baseline.

The primary endpoint was HbA1c change from baseline at week 12. Secondary endpoints were the change from baseline in body weight, fasting serum glucose, and glucose assessed by continuous glucose monitoring. Safety was also evaluated.

The following were the key findings of the study:

• Participants were 58.3 years on average, with baseline HbA1c 7.39%, BMI 35.18 kg/m2, and T2D duration around 12.4 years, and included 55% females.
• Semaglutide (55%) and dulaglutide (42%) were the most commonly used GLP-1 RAs at baseline, with semaglutide 1.0 mg and dulaglutide 1.5 mg being the most common treatment doses.
• At week 12, mean HbA1c changed from baseline by -0.43%, fasting serum glucose by -7.83 mg/dL, and body weight by -2.15 kg.
• Body weight and glycemic outcomes improved in participants in all baseline GLP-1 RA subgroups.
• 13.2% of participants developed gastrointestinal events. 2% of participants discontinued tirzepatide due to adverse events. There were no severe hypoglycemic events or deaths.

In the prospective study, when patients with type 2 diabetes on stable GLP-1 RA treatment were switched directly to tirzepatide 5 mg, they experienced additional weight reduction and improved glycemic outcomes with an acceptable risk of adverse gastrointestinal events over 12 weeks.

Reference:

Jabbour S, Paik JS, Aleppo G, Sharma P, Gomez Valderas E, Benneyworth BD. Switching to Tirzepatide 5 mg From Glucagon-Like Peptide-1 Receptor Agonists: Clinical Expectations in the First 12 Weeks of Treatment. Endocr Pract. 2024 May 8:S1530-891X(24)00515-9. doi: 10.1016/j.eprac.2024.05.005. Epub ahead of print. PMID: 38723893.