Let’s get ready to rumble!
Welcome to the showdown of the decade! A modern David vs. Goliath! GLP-1 vs. GLP-1! Today’s showdown is between Ozempic and Trulicity in the SUSTAIN-7 clinical trial! *Cheering* *Crowd goes wild*
Ok, maybe we are getting a bit carried away, but head-to-head drug trials are kind of a big deal in the pharmaceutical world! The reason being is they don’t usually occur.
Why might you ask?
Imagine if you were a big drug company with shareholders, profits to lose, etc., and you just spent ~$1 billion and ~10 years to bring a drug to market. One day you thought, “Hey, let’s do a study where we compare our new fancy drug against our direct competitor currently on the market.” If that study shows your competitor has the better drug, well, someone will likely be losing their job. So a drug company wouldn’t be too keen on a trial like that unless they were sure their drug was either better or at least as good as!
So it makes total sense why this is a modern Rocky vs. Apollo?! Right?
In comes the SUSTAIN-7 trial….
The SUSTAIN-7 trial compared the GLP-1 RAs Ozempic and Trulicity against each other in individuals that had type 2 diabetes over a 40-week period. You can find out more about how these drugs work here.
Now, hang on tight as I am going to throw another trial type at you. The SUSTAIN-7 trial was a randomized, open-label, active-controlled, parallel, four-armed trial. English translation: This was a randomized controlled trial with four different treatment groups, and everyone plus their dog knew who was getting what drug and dose.
When participants and researchers are not blinded, it can lead to biases. For example, participants may adhere to the protocol better or receive more encouragement from researchers because they received the newer ‘special’ drug from a company that the researcher may or may not have financial shares. Humans are funny creatures.
Anywho, the authors of this study Pratley, et al., had four groups of participants that received the following:
- Trulicity (Dulaglutide) 0.75mg once weekly
- Ozempic (Semaglutide) 0.5mg once weekly
- Trulicity (Dulaglutide) 1.5mg once weekly
- Ozempic (Semaglutide) 1mg once weekly
They wanted to see which drug was more effective and safer in managing blood sugars in individuals with type 2 diabetes on metformin, and their blood sugar levels were still elevated.
What were the results of the SUSTAIN-7 trial?
Pratley and friends found some pretty decent results:
- Trulicity 0.75mg once weekly – reduced A1C by 1.1% and weight by 2.3kg
- Ozempic 0.5mg once weekly – reduced A1C by 1.5% and weight by 4.6kg
- Trulicity 1.5mg once weekly – reduced A1C by 1.4% and weight by 3.0kg
- Ozempic 1mg once weekly – reduced A1C by 1.8% and weight by 6.5kg
Not too shabby of results, considering there was no mention of lifestyle interventions also being implemented either! It was just Ozempic or Trulicity being added to metformin, and the weight loss seen with Ozempic at both doses was double that seen with Trulicity! It is not entirely clear why Ozempic is so much more effective. However, the authors did speculate that since Trulicity is a larger molecule, it might have more struggles crossing the blood-brain barrier! Kind of like trying to pass through airport security with a pair of nail clippers – you may or may not be pulled aside for a cavity search.
As for safety, there were no major side effects with either drug. Just the usual and expected GI side effects that come with the GLP-1 RAs, such as nausea, diarrhea, and vomiting. These happened at similar rates between the two drugs.
Ozempic lived up to the drug company’s expectations and blew Trulicity out of the water. I am sure the shareholders were very excited.
What does this mean for you?
I can confirm these results are what I also see in practice. In fact, I have yet to see a drug that is as effective as Ozempic in lowering blood sugar levels and supporting weight loss. It is the most potent GLP-1 RA I have ever worked with. However, contrary to what was seen in the trial, I find that Ozempic has considerably more side effects. For patients that can’t tolerate the GI side effects with Ozempic, I will switch them to Trulicity or another GLP-1 RA because I see a much lower incidence of side effects! Obviously, this is just my anecdotal experience, so you can take it how you would like. Just wait till I get my results published, and I will show you!
Alas, that is all, folks. The showdown of the decade ended with Ozempic being the clear winner in both blood sugar and weight management control! Trulicity is still an effective drug, and if it happens to be the one you are on, that is totally OK. Will you get further benefit from switching to Ozempic?! Maybe, but you might not as well! As always, discuss with your care team, and of course, remember that small tweaks lead to massive peaks!
Until next time,
– Dr. Dan
Pratley, R. E., Aroda, V. R., Lingvay, I., Lüdemann, J., Andreassen, C., Navarria, A., Viljoen, A., & SUSTAIN 7 investigators (2018). Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. The lancet. Diabetes & endocrinology, 6(4), 275–286. PMID: 29397376.