Use of Soliqua in Weight Loss

Use of Soliqua in Weight Loss 

Established as a collaboration between national and provincial governments in 1989, Canadian Agency for Drugs and Technologies in Health (CADTH) can guide pharmaceutical companies during early stages of research and development towards evidence needed to reduce uncertainty as they move further into the development of drugs and technology products for use in healthcare.  In their systematic review of Soliqua, a GLP-1 receptor agonist, it was found to have greater efficacy in reducing plasma glucose levels among those with Type 2 Diabetes Mellitus (T2DM).  More patients achieved A1C < 7.0% when adding Soliqua to their basal insulin (Canadian Agency for Drugs and Technologies in Health, 2019).  Even though some participants experienced some degree of weight loss when basal insulin was used in conjunction with another oral antidiabetic drug, participants experienced greater weight loss while on Soliqua.  Notable points are Soliqua’a ability to reduce hypoglycemic events, often experienced when basal insulin and bolus insulin are used, and its greater weight reduction; a common problem with insulin regimens as well as DPP-4 drugs.   

Main Points for Clinical Practice

The daily burdens of managing their diabetes outweigh the potential long-term consequences from poor glucose control for many T2DM patients.  Daily monitoring of blood glucose through pricking oneself for blood samples, adjusting insulin doses as needed, and self-administration through injections are just some of the common complaints reported by many patients with diabetes.  Additionally, approximately 85% of those with T2DM are struggling with being overweight, which adds another complicated dynamic to managing the disease process (Canadian Agency for Drugs and Technologies in Health, 2019).  As T2DM progresses, patients may require insulin as an adjunct to their oral antidiabetic drugs.  There is a higher risk and incidence of hypoglycemia when insulin is added to the treatment regimen, a risk which has been virtually eliminated with the use of Soliqua.  The use of Soliqua in clinical practice will improve our patients’ compliance to treatment regimens because it will have eliminated some of the most onerous burdens in T2DM; polypharmacy and treatment complexities, and hypoglycemic events affecting their quality of life (Handelsman et al., 2019).  Additionally, through its effect on rapid gastric emptying, Soliqua provides greater glycemic control and can mitigate the weight gain often associated with insulin use (Canadian Agency for Drugs and Technologies in Health, 2019). 

Opinion of Article

CADTH provided a clear analysis of using Soliqua vs. insulin alone in treating T2DM.  This clinical trial maximized the validity of its results by selecting measured outcomes based on treatment results most relevant to its users; the patients.  Thoroughly investigating adverse effects of each treatment arm, grouping outcomes by treatment regimen, and identifying primary and secondary endpoints prior to beginning the study were useful in establishing the internal validity of this study.  The study also conceded to possible multiplicity issues, possible type 1 error from therapy efficacy achieved in one or both endpoints, but each group of endpoints encompasses symptoms and results that are most important to patients with T2DM, so in either case, the results remain clinically significant.  Patient preference is a driving factor in adherence to plans of care, presenting treatments as successes based on expected outcomes (endpoints) will increase the likelihood for our patients to be committed to their regimens.  

Recommendations for Use

Particularly for those with a long history of uncontrolled T2DM, the addition of another medication can be defeating and discouraging, and often, leading to noncompliance.  Among the many side effects from various oral agents used in T2DM, hypoglycemia, weight gain, and decrease in quality of life are among the most complained.  With approximately 90% obesity rate among new T2DM patients (Canadian Agency for Drugs and Technologies in Health, 2019), the question is not whether they will need insulin throughout their lives, but rather, how can we best prepare them to accept this inevitable outcome?  By combining two drugs (insulin glargine and GLP-1 receptor agonist), Soliqua was able to mitigate the weight gain often experienced with insulin, with an even greater effect when started earlier.  With Soliqua’s advantages in rapid gastric emptying, patients achieving greater glycemic control (especially those having difficulties in controlling their blood sugars),  the simplicity of a once-daily injection, and its fewer occurrences of hypoglycemia, Soliqua can help patients by minimizing a heavy burden of T2DM through its positive impact on their quality of life.

References

• Canadian Agency for Drugs and Technologies in Health. (2019). Clinical Review Report: Insulin glargine and lixisenatide injection (Soliqua): (Sanofi-Aventis): Indication: adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus inadequately controlled on basal insulin (less than 60 units daily) alone or in combination with metformin. CADTH Common Drug Review.
• Handelsman, Y., Chovanes, C., Dex, T., Giorgino, F., Skolnik, N., Souhami, E., . . . Frias, J. P. (2019). Efficacy and safety of insulin glargine/lixisenatide (iGlarLixi) fixed-ratio combination in older adults with type 2 diabetes. Journal of Diabetes and Its Complications, 33(3), 236-242. doi:10.1016/j.jdiacomp.2018.11.009