english.prescrire.org > Spotlight > Archives : 2017 > Diabetes: avoid insulin degludec in combination with liraglutide

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Diabetes: avoid insulin degludec in combination with liraglutide

In patients with type 2 diabetes, the combination of insulin degludec and liraglutide in an injection pen has more disadvantages than advantages.

In patients with type 2 diabetes, when metformin does not provide satisfactory glycaemic control, there is no evidence that the combination of liraglutide with an insulin is of any benefit in preventing clinical complications of diabetes.

A fixed-dose combination in an injection pen of insulin degludec, a long-acting insulin, and liraglutide, a GLP-1 analogue (Xultophy°), has been authorised in the European Union.
Insulin degludec has no proven benefits over other insulins. Like the other GLP-1 analogues, liraglutide mainly exposes patients to nausea, renal failure, and more rarely to pancreatitis.

Cancers of the pancreas and thyroid have been reported.

The combination of insulin degludec and liraglutide in a single pen does not allow the dosage of each substance to be adjusted independently, in particular at the start of treatment or in the case of an adverse effect. This is one of the arguments that led 14 out of 32 members of the European Medicines Agency’s marketing authorisation committee to vote against the granting of a marketing authorisation. 

It is best to rule out this drug combination.

©Prescrire 1 May 2017

"Insulin degludec + liraglutide (Xultophy°) in type 2 diabetes. A drug to avoid" Prescrire Int 2017; 26 (182): 121. (Pdf, subscribers only).
Download the full review.
Pdf, subscribers only

See also:

Insulin degludec: no better
than other insulins, and an
ill-defined cardiovascular risk
(June 2014)
Free