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Tirzepatide Vs Trulicity (Mounjaro Vs Dulaglutide)

Tirzepatide vs Trulicity

Tirzepatide vs Trulicity Mounjaro vs Dulaglutide

Tirzepatide Vs Trulicity (Dulaglutide): A comparison of the efficacy of the two drugs in obese patients with diabetes is presented here based on the results of the recent clinical trials.

Tirzepatide (Mounjaro) has recently been approved for the treatment of patients with Diabetes mellitus Type 2 (13th May 2022). Trulicity (Dulaglutide), on the other hand, has been in the market since 2014.

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Tirzepatide Vs Trulicity: Comparing Pharmacokinetics and Dynamics:

Tirzepatide and Dulaglutide are both marketed by Eli Lilly Pharmaceuticals. Both drugs are administered as a subcutaneous injection once weekly into the skin of the anterior abdomen, thigh, or upper arm.

Tirzepatide differs from Trulicity as it activates both GLP-1 and GIP. Trulicity (Dulaglutide) on the other hand is a pure GLP-1 agonist.

Both Trulicity and Tirzapatide have been approved for the treatment of Diabetes Mellitus type 2. However, Eli Lilly is pushing for its approval as a weight-loss drug since it has superior weight-loss effects.

A general comparison between the two drugs is summarized here:

Tirzepatide

Dulaglutide

Drug Class Dual GLP-1 and GIP analog GLP-1 analog
Manufacturer’s Names Eli Lilly Eli Lilly
Brand names Mounjaro Trulicity
Formulations available Subcutaneous Injection Subcutaneous Injection
Indications FDA-approved for Diabetes. May soon get approval as a weight-loss drug FDA-approved for Diabetes only
Cost Comparison Retail price:

  • $ 12,666 USD per year
  • $ 1,055 USD per month
  • $ 263 USD per injection
  • 0.75 mg/ml: USD 227.82
  • 1.5 mg/ml: USD 227.82

Per year cost:

  • $10,896 USD
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Pharmacokinetics Comparisons of Tirzepatide Vs Dulaglutide:

The pharmacokinetics of Tirzepatide and Trulicity are almost similar. Both drugs are administered subcutaneously. The bioavailability after subQ administration differs for the two drugs.

Tirzepatide has a bioavailability of about 80% while the absolute bioavailability of Trulicity is about 65%.

The steady-state concentration of both drugs can be achieved in about 4 weeks. The table below summarizes the general pharmacological differences between the two drugs.

Tirzepatide (Mounjaro)

Dulaglutide (Trulicity)

Peak Plasma concentrations 8 – 72 hours after a single dose 24 to 72 hours
Half-life elimination Five days Five days
Excretion/ Metabolism Metabolized into peptides It is metabolized into amino acids in the body
Administration It is administered once weekly as a subcutaneous injection It is administered once weekly subcutaneously into the anterior abdomen.

Trulicity is administered in a fixed dose of 7.5 mg or 1.5 mg injection weekly. Tirzepatide is available in three different doses.

To ensure the tolerability of Tirzepatide, it is initially administered in a low dose and gradually titrated up to the maximum effective and tolerable dose.

tirzepatide mounjaro dose titration
Tirzepatide (Mounjaro) dose Escalation
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Tirzepatide Vs Trulicity: Comparing Efficacy in Diabetes Mellitus:

Tirzepatide was compared with Dulaglutide in a multicentered phase 2 randomized double-blind placebo-controlled clinical trial.

All the participants included in the study had:

  • Diabetes Mellitus Type 2 for at least six months with glycated hemoglobin of 7% to 10.5%
  • They were between 18 and 75 years of age
  • Patients had inadequate diabetes control despite exercise and diet and/ or metformin for at least three months or more
  • Participants in the study had a baseline BMI ranging from 23 to 50 kg/m².

Subgroups were made based on:

  • Baseline Glycated hemoglobin of <8.5% vs >8.5%
  • Metformin users vs those on diet and exercise only
  • BMI of <30 kg/m² vs BMI of more than 30 kg/m²

The participants received Tirzepatide in various doses (1 mg, 5 mg, 10 mg, and 15 mg), Trulicity in a dose of 1.5 mg, and Placebo.

Tirzepatide in doses of 5 mg, 10 mg, and 15 mg was superior to Dulaglutide in lowering blood glucose as measured by the A1C after 26 weeks of treatment.

A summary of the HbA1C-reducing effects of the two drugs is presented in the table below:

Drug

Dose

Mean HbA1C reduction

Placebo -0.06%
Tirzepatide 1 mg -1.06%
5 mg -1.73%
10 mg -1.89%
15 mg -1.94%
Dulaglutide 1.5 mg -1.21%

Tirzepatide lowered the A1C by up to 1.94% which is probably the highest ever recorded with any of the existing FDA-approved Diabetes medicines.

hba1c reduction tirzepatide vs trulicity dulaglutide
The efficacy of Tirzepatide (Mounjaro) vs Dulaglutide (Trulicity) in the treatment of Diabetes Mellitus Type 2.
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Tirzepatide has even been shown to be superior to Semaglutide, which, until now was considered the most effective diabetes medication. It lowers the A1C by up to 1.8%.

Results of the SURPASS 2 clinical trial that compared the efficacy of Tirzepatide Vs Semaglutide.

Tirzepatide was shown to have superior efficacy in lowering blood glucose as measured by the A1C at the end of the study period.

Results of the SURPASS 2 Clinical Trial that compared Tirzepatide vs Semaglutide are summarized in the table below [Ref]:

Drug

Dose

Baseline HbA1C

Mean HbA1C reduction

Semaglutide 1 mg 8.25% -1.86%
Tirzepatide 5 mg 8.32% -2.01%
10 mg 8.30 -2.24%
15 mg 8.26 -2.30%
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Tirzepatide Vs Trulicity: Comparing Weight loss effects:

Weight loss is one of the desirable effects of the novel GLP-1 and GIP analogs. Among the six FDA-approved weight-loss drugs, Liraglutide (Saxenda) and Semaglutide (Wegovy) are from the same class, the GLP-1 analogs.

Although Trulicity (Dulaglutide) has not been approved as a weight-loss drug, it has also been associated with significant weight loss when compared with a placebo.

Trulicity (Dulaglutide) has been associated with a mean weight loss of about 2.3 kgs in clinical trials.

In a trial comparing Tirzepatide vs Dulaglutide, Tirzepatide (Mounjaro) resulted in significant weight loss compared to Trulicity (Dulaglutide).

The results of the clinical trial are presented here:

Drug

Dose

Mean weight loss (kgs)

Placebo -0.4 (0.88 pounds)
Dulaglutide (Trulicity) 1.5 mg -2.7 (5.95 pounds)
Tirzepatide 1 mg -0.9 (1.98 pounds)
5 mg -4.8 (10.58 pounds)
10 mg -8.7 (19.18 pounds)
15 mg -11.3 (24.91 pounds)

Trulicity was associated with a weight loss of 2.7 kgs (5.95 pounds). Tirzepatide even in lower doses of 5 mg weekly was associated with greater weight loss.

A summary of the weight loss effect of Tirzepatide in different doses compared to Trulicity:

  • Tirzepatide 5 mg was associated with 1.8 times greater weight loss than Dulaglutide.
  • Tirzepatide 10 mg was associated with 3.2 times greater weight loss than Trulicity (Dulaglutide).
  • Tirzepatide 15 mg was associated with 4.2 times greater weight loss than Dulaglutide.

A greater percentage of patients achieved 5% or more weight loss in the Tirzepatide group compared to Dulaglutide. The results are summarized in the table below:

Drug

Dose

Percentage of patients with >5% weight loss

Placebo 0
Dulaglutide 1.5 mg 22.2
Tirzepatide 1 mg 13.5
5 mg 47.3
10 mg 70.6
15 mg 62.3

Tirzepatide superiority as a weight-loss drug can be seen here. Almost 2/3 rds of the patients in the study had a weight loss of 5% or more with Tirzepatide compared to 1/4th in the Dulaglutide group.

Similarly, 10% or more weight loss was noted in a greater percentage of patients in the Tirzepatide group compared to Trulicity:

Drug

Dose

Percentage of patients with >10% weight loss

Placebo 0
Dulaglutide 1.5 mg 9.3
Tirzepatide 1 mg 5.8
5 mg 16.4
10 mg 39.2
15 mg 37.7

10% or more weight loss was seen in only about 10% of the patients in the Trulicity group. On the other hand, about 40% of the patients in the Tirzepatide group had a weight loss of 10% or more.

Lastly, 15% or more weight loss is a significant weight loss. Patients who achieve 15% or more weight loss may reverse most obesity-related complications including sleep apnea, diabetes, and hypertension.

15% or more weight loss occurred in only 2% of the patients treated with Trulicity. However, up to 20 – 24% of the patients in the Tirzepatide group lost 15% or more weight.

The table summarizes the results below:

Drug

Dose

Percentage of patients with >10% weight loss

Placebo 0
Dulaglutide 1.5 mg 1.9
Tirzepatide 1 mg 0
5 mg 5.5
10 mg 21.6
15 mg 24.5

Here is a summary of 5%, 10%, and 15% weight loss in the Tirzepatide Vs Trulicity groups:

Dulaglutide 1.5 mg

Tirzepatide 1 mg Tirzepatide 5 mg Tirzepatide 10 mg

Tirzepatide 15 mg

>5% weight loss 22.2 13.5 47.3 70.6 62.3
>10% weight loss 9.3 5.8 16.4 39.2 37.7
>15% weight loss 1.9 0 5.5 21.6 24.5
weight loss comparison tirzepatide vs trulicity dulaglutide
Weight Loss comparison of Tirzepatide vs Trulicity (Dulaglutide)
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Not only did Tirzepatide show superiority as a weight-loss drug when compared with Dulaglutide, but the SURPASS 2 clinical trial has also demonstrated the superiority of Tirzepatide over Semaglutide.

The weight loss summary of Tirzepatide vs Semaglutide is presented below [Ref]:

Drug

Dose Baseline Body Weight Absolute Weight loss

Percentage weight loss

Semaglutide 1 mg 93.7 -5.7 -6.7
Tirzepatide 5 mg 92.5 -7.6 -8.5
10 mg 94.8 -9.3 -11
15 mg 93.8 -11.2 -13.1
weight loss comparison of tirzepatide vs semaglutide
Weight Loss comparison of Tirzepatide vs Semaglutide (Ozempic)

In Conclusion:

Tirzepatide is associated with greater weight loss and better blood glucose control compared to Trulicity. Tirzepatide is even more effective than Semaglutide.

Real-world experiences of patients will soon reveal the true benefits of the drug. It might also replace bariatric surgery, especially in elderly patients who can not tolerate anesthesia and complications of surgery.

Cost is one factor that might limit its use, however, insurance coverage might ease the burden on most people.

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What do you think?

Written by Diabetes Doctor

I am an Internist practicing medicine for the last fifteen years. Over the years, I have learned that medicine is not about prescribing pills. True medical practice is helping people.
I do prescribe pills as well but the best results I get are when I motivate people to overcome their problems with little changes in their lifestyles.
Since most of my patients are obese and have diabetes, hypertension, and high cholesterol levels, I am writing at dibesity.com when free.
Dibesity, I know the correct word is diabesity. Ignore this! Be with us.
Also, you can contact me directly at dibesity.com@gmail.com

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