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GLP-1 receptor agonist-based drug shortages and suggested comparative doses for treating type 2 diabetes

GLP-1 receptor agonist-based drug shortages and suggested comparative doses for treating type 2 diabetes
Agent Dosing route and interval Comparative doses
Exenatide SUBQ twice daily 5 mcg* 10 mcg – – – – – – – –
Lixisenatide (not available in the United States or Canada) SUBQ once daily 10 mcg* 20 mcg – – – – – – – –
Liraglutide SUBQ once daily 0.6 mg* 1.2 mg 1.8 mg – – – – – – –
Exenatide extended release SUBQ once weekly – – 2 mg – – – – – – –
Dulaglutide SUBQ once weekly – 0.75 mg*¶ 1.5 mg 3 mgΔ[1] 4.5 mgΔ[1] – – – – –
Semaglutide SUBQ once weekly – 0.25 mg*Δ 0.5 mgΔ – 1 mg 2 mg¶[2] – – – –
Oral once daily (formulation R1) 3 mg* 7 mg 14 mg – – – – – – –
Oral once daily (formulation R2) 1.5 mg 4 mg 9 mg – – – – – – –
Tirzepatide SUBQ once weekly – – 2.5 mg*¶ – – 5 mg¶[2] 7.5 mg 10 mg 12.5 mg 15 mg
According to the US Food and Drug Administration's (FDA) drug shortage database as of 10 March 2023[3], patients may have limited or intermittent access in community pharmacies to 3 agents in varying doses: dulaglutide, injectable semaglutide, and tirzepatide. Specific drug shortages may vary over time and across regions.

GLP-1: glucagon-like peptide 1; SUBQ: subcutaneous.

* Comparative efficacy of starting doses is not known and based on the clinical judgement of authors.

¶ Drug doses that are currently in short supply but still available.

Δ Drug doses with only limited or intermittent availability.

References:
  1. Frias JP, Bonora E, Nevarez Ruiz L, et al. Efficacy and safety of dulaglutide 3.0 mg and 4.5 mg versus dulaglutide 1.5 mg in metformin-treated patients with type 2 diabetes in a randomized controlled trial (AWARD-11). Diabetes Care 2021; 44:765.
  2. Vadher K, Patel H, Mody R, et al. Efficacy of tirzepatide 5, 10 and 15 mg versus semaglutide 2 mg in patients with type 2 diabetes: An adjusted indirect treatment comparison. Diabetes Obes Metab 2022; 24:1861.
  3. FDA drug shortages. US Food and Drug Administration. https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm (Accessed on March 10, 2023).

From: American Diabetes Association. Whitley HP, Trujillo JM, Neumiller JJ. Special report: Potential strategies for addressing GLP-1 and dual GLP-1/GIP receptor agonist shortages. Clin Diabetes 2023; 41:467. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association.

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