Some Diabetes Drugs Used in Combination Provide No Added Benefit

Some Diabetes Drugs Used in Combination Provide No Added Benefit

February 19th, 2019 | Clinical ConnectionsPharmacy Pearls

The AHP Pharmacy Task Force works to identify opportunities that will enhance the quality, safety and value of medication treatment for our patients. Recently, we identified a cohort of patients across the PCN on duplicate therapy for Type 2 Diabetes with a GLP-1 agonist (e.g., Victoza, Trulicity, Byetta, Bydureon) and a DPP-4 inhibitor (e.g., Januvia, Tradjenta).

Based on mechanism of action, it is common to think that using these agents in combination would result in increased incretin concentrations and improved diabetic control; however, this is not the case (see below). This combination has been associated with minimal additive therapeutic benefit (HbA1c reduction of only 0.3%) and is associated with a theoretical risk of increased side effects (e.g., Pancreatitis).

In the next few weeks we will be sending communication to providers who have patients on concomitant GLP-1 agonist and DPP-4 inhibitor therapy. If you receive a message, we ask that you please take a moment to review the patient and optimize diabetes medication management:
What to do if your patient is on a DPP-4 and a GLP-1?
o Preferred Option: Continue GLP-1 agonist and Discontinue DPP-4 inhibitor
o Alternative Option: Continue DPP-4 inhibitor and Discontinue GLP-1 agonist
o No taper is necessary when discontinuing either medication
Please note: You, or an office staff member on your behalf, may also need to contact patients’ retail pharmacies to void existing refills after discontinuation.