Approval of Trulicity (dulaglutide) marks a new era in diabetes management for New Zealanders

Eli Lilly is pleased to announce that Trulicity, a glucagon-like peptide receptor agonist (GLP-1 RA) is now approved and available in New Zealand for adults with type 2diabetes (T2D).

It is also the first and only GLP-1 RA to be funded in New Zealand.^1,2

Trulicity is indicated as an adjunct to diet and exercise in adults with T2D, as a monotherapy or incombination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control.¹ Trulicity is also indicated as an adjunct to standard of care therapy to reduce the risk of major adverse cardiovascular events in patients with T2D who have established cardiovascular disease (CVD) or have multiple cardiovascular risk factors.¹

In Aotearoa, 228,000 people live with T2D, and the prevalence is set to increase by 70-90 per cent in the next 20 years.³ T2D also disproportionately affects Pacific, Asian and Māori peoples.⁴ The progressive condition is caused by the body becoming resistant to the normal effects of insulin and/or gradually losing the capacity to produce enough insulin.

Reflecting international consensus statements, the New Zealand Society for the Study of Diabetesrecommends that the class of GLP-1s are useful alternatives to starting basal insulin for patients with T2D.³ Trulicity is a once-weekly treatment that works in the same way as the body’s natural GLP-1 hormone in the presence of high blood sugar, stimulating both the pancreas to produce insulin, and suppressing production of glucose by the liver. As a long-acting GLP-1, TRUCILITY has demonstrated sustained glycaemic control by lowering both fasting and post-meal glucose levels.

Dr Ryan Paul, Executive Member of the New Zealand Society for the Study of Diabetes (NZSSD) andConvenor of the NZSSD and Ministry of Health guidance on the management of type 2 diabetescomments:

“It is great to finally have a funded GLP1 receptor agonist available in Aotearoa New Zealand as they are currently the most potent non-insulin glucose lowering agents and importantly, unlike insulin, they may lead to weight loss, and do not cause hypoglycaemia alone.

“In addition, dulaglutide has been shown to reduce cardiovascular disease independently of glycaemic control. Therefore, the funding of dulaglutide is a significant addition to the armoury in improving the outcomes of New Zealanders with type 2 diabetes and addressing the inequities within.”

T2D is the leading cause of preventable CVD in New Zealand and people living with T2D are two to four times more likely to suffer from CVD.⁵ This includes higher risk of major adverse cardiac (MACE) events such as stroke, myocardial infarction and sudden cardiac death.³ Although screening for diabetes and cardiovascular complications has improved over the years,³ there has not been a funded diabetes treatment option available to New Zealanders who are at high risk of cardiovascular complications from T2D.²

The Trulicity registration was based on the efficacy established in eight pivotal Phase 3 studies(AWARD) involving 5,770 patients with T2D. The AWARD studies indicated Trulicity’s safety profilewas consistent with the GLP-1 receptor agonist class.^6-11 The REWIND study 12 involved 9,901 patients with T2D and showed a significant reduction in risk of major adverse cardiovascular events (MACE), a composite endpoint of nonfatal myocardial infarction (heart attack), nonfatal stroke or cardiovascular death. Results demonstrated consistent MACE risk reduction with Trulicity across major demographic and disease subgroups.

Trulicity is now funded by the New Zealand Pharmaceutical Schedule, Pharmac, for patients with T2D subject to Special Authority for subsidy.¹³ **

References

1. Medsafe. Trulicity (dulaglutide 1.5 mg/0.5 mL) New Zealand Data Sheet. Available at:

http://www.medsafe.govt.nz/Profs/Datasheet/t/trulicityinj.pdf Accessed August 2021.

2. Pharmac. Decision to fund two new medicines for type 2 diabetes - Amended with Q&A. Available at:

https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/…-

type-2-diabetes/ Accessed June 2021.

3. New Zealand Society for the Study of Diabetes (NZSSD). GLP-1 receptor agonists. (GLP1RA). Available at:

https://t2dm.nzssd.org.nz /Section-82-GLP-1-receptor-agonists--GLP1RA- Accessed June 2021.

4. Diabetes NZ. The Economic and Social Cost of Type 2 Diabetes. Available at: https://healthierlives.co.nz/wpcontent/

uploads/Economic-and-Social-Cost-of-Type-2-Diabetes-FINAL-REPORT.pdf Accessed June 2021.

5. Ministry of Health. Targeting Diabetes and Cardiovascular Disease. Available at:

https://www.health.govt.nz/system/files/documents/publications/targetin…

Accessed June 2021.

6. Dungan KM, et al. Diabetes Obes Metab. 12 Sept 2015

7. Giorgino F, et al. Diabetes Care. 2015;38(12):2241–9

8. Umpierrez G, et al. Diabetes Care. 2014;37(8):2168–76.

9. Weinstock, RS et al. Diabetes, Obesity and Metabolism 2015; 17:849–858.

10. Skrivanek Z, et al. Diabetes Obes Metab. 2014;16(8):748–56.

11. Tuttle KR, et al. Lancet Diabetes Endocrinol. 2018;6(8):605–17.

12. Gerstein HC et al. Lancet 2019;394:121–30.

13. Pharmaceutical Management Agency New Zealand Pharmaceutical Schedule. Update September 2021. Available

at: https://schedule.pharmac.govt.nz/2021/08/18/SU.pdf Accessed August 2021.

14.Health Navigator. HbA1c test – diagnosing diabetes and pre-diabetes. Available at:

https://www.healthnavigator.org.nz/health-a-z/h/hba1c-testing/ Accessed June 2021.