Ozempic vs Trulicity: Comparing Efficacy, Side Effects, and Costs

Managing type 2 diabetes often requires adding injectable medications to stimulate insulin production and control blood sugar.

Two popular options in this medication class are Ozempic and Trulicity, which belong to the glucagon-like peptide-1 (GLP-1) receptor agonist family.

This article provides a comprehensive comparison of these two once-weekly injectable diabetes drugs to help patients and providers determine the most appropriate treatment choice.

Key factors examined include mechanism of action, administration, and dosing, clinical efficacy based on study data for glycemic control and weight loss, common and serious side effects, cost considerations, and available savings programs.

1. Mechanism of Action

As GLP-1 receptor agonists, Ozempic and Trulicity bind to GLP-1 receptors to stimulate insulin secretion. However, the specific binding profiles may differ. Let’s explore them below.

Ozempic

Ozempic, or semaglutide, belongs to the class of medicines called glucagon-like peptide-1 (GLP-1) agonists or incretin mimetics. It works by binding to GLP-1 receptors, which are found in various tissues, including the pancreas. By binding to these receptors, Ozempic stimulates insulin release from the pancreas. This insulin release helps lower blood sugar levels in individuals with type 2 diabetes.

Additionally, Ozempic reduces glucose production by the liver and slows down the rate at which food passes through the digestive system. The combined effects improve blood sugar control and may also reduce appetite, aiding in weight loss.

Trulicity

Trulicity, or dulaglutide, is also an incretin mimetic belonging to the GLP-1 receptor agonist class. Its mechanism of action is similar to Ozempic. Trulicity works by binding to GLP-1 receptors, particularly in the pancreas. This binding stimulates the release of insulin, which helps regulate blood sugar levels in individuals with type 2 diabetes.

Like Ozempic, Trulicity also reduces glucose production by the liver and may slow down stomach emptying. These combined actions improve glycemic control and may have additional benefits such as weight loss.

2. Dosage and Administration

The dosing regimen for Ozempic and Trulicity follows a gradual titration schedule to minimize side effects. Here’s an overview.

Ozempic

Ozempic is designed for once-weekly subcutaneous injection and follows a specific dosage and administration protocol.

To initiate treatment, start with a 0.25 mg subcutaneous injection once weekly for the first 4 weeks. This initial dose serves as a starting point but is ineffective for glycemic control. After this initiation phase, increase the dosage to 0.5 mg once weekly.

If additional glycemic control is needed, the dosage may be further increased to 1 mg once weekly after at least 4 weeks on the 0.5 mg dose. The maximum recommended dosage is 2 mg once weekly, and this can be considered if further control is necessary after at least 4 weeks on the 1 mg dose.

Ozempic should be administered once weekly on the same day each week, with the flexibility to change the day if needed, ensuring a minimum of 2 days (>48 hours) between doses. In case of a missed dose, administer the injection as soon as possible, within 5 days after the missed dose.

Dispose of the injection pen 56 days after the first use or if less than 0.25 mg is left on the dose counter. Injection sites should be rotated to avoid injecting into the exact location consecutively.

Trulicity

Like Ozempic, Trulicity is administered as a once-weekly subcutaneous injection and follows a structured dosage and administration plan.

Start with a 0.75 mg subcutaneous injection as the initial dose once a week. Dose adjustment may be necessary for additional glycemic control, with increments of 1.5 mg. Patients should remain on the 3 mg once-weekly dose for at least 4 weeks before considering an increase to the maximum dose of 4.5 mg once weekly.

Trulicity should be administered on the same day each week, and if changing the dosing day, allow at least 3 days between doses. The injection can be administered with or without food.

In case of a missed dose, use the medicine immediately, avoiding two doses within 72 hours.

Unused Trulicity Pens should be stored in the refrigerator, shielded from light. However, these pens can be stored at room temperature for up to 14 days before use. Rotate injection sites to different locations to prevent consecutive injections in the same area.

3. Efficacy

The comparison between Ozempic and Trulicity in the SUSTAIN 7 trial showed that Ozempic demonstrated superior efficacy in A1C reduction and glycemic control in patients with type 2 diabetes compared to Trulicity. In terms of weight reduction, Ozempic also outperformed Trulicity, even though Ozempic is not indicated for weight loss.

The study, conducted over 40 weeks, revealed that Ozempic delivered a more significant mean reduction in A1C from baseline compared to Trulicity, and a higher percentage of patients achieved A1C <7% with Ozempic. Additionally, Ozempic demonstrated superior body weight reduction compared to Trulicity as a secondary endpoint. The weight reduction with Ozempic was more than double that observed with Trulicity in each dose comparison.

While Ozempic showcased notable efficacy in A1C reduction and weight management, it's important to note that SUSTAIN 7 did not specifically evaluate the relative safety between Ozempic and Trulicity. The everyday adverse events reported in SUSTAIN 7 were not designed for safety comparison between the two medications.

Overall, based on the SUSTAIN 7 trial results, Ozempic appears to be a promising option for patients with type 2 diabetes, providing significant and superior glycemic control and notable weight reduction compared to Trulicity.

4. Side Effects

As with any medication, Ozempic and Trulicity may cause side effects ranging from mild to severe. Here’s a breakdown.

Ozempic

Ozempic, like any medication, may cause side effects. Common side effects include:

• Low blood sugar in people with type 2 diabetes
• Upset stomach, heartburn, burping, gas, bloating
• Nausea, vomiting, stomach pain, loss of appetite
• Diarrhea, constipation
• Runny nose or sore throat
• Stomach flu symptoms
• Headache, dizziness, tiredness

Serious side effects that require immediate medical attention:

• Allergic reaction: Hives, itching, dizziness, fast heartbeats, difficulty breathing, swelling of face, lips, tongue, or throat.
• Vision changes
• Unusual mood changes, thoughts about hurting oneself
• Pounding heartbeats or fluttering in the chest
• Light-headed feeling, feeling like you might pass out
• Signs of a thyroid tumor: Swelling or lump in the neck, trouble swallowing, hoarse voice, shortness of breath
• Symptoms of pancreatitis: Severe pain in the upper stomach, spreading to the back, nausea with or without vomiting, fast heart rate
• Gallbladder problems: Upper stomach pain, fever, clay-colored stools, jaundice
• Low blood sugar: Headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, feeling jittery
• Kidney problems: Swelling, urinating less, blood in urine, feeling tired or short of breath
• Symptoms of ileus (stomach paralysis): Bloating, stomach cramps or pain, nausea or vomiting, constipation or diarrhea, loss of appetite

This is not an exhaustive list, and other side effects may occur. Any unusual or severe symptoms should be reported to a healthcare provider promptly.

Trulicity

Trulicity also has potential side effects. Common side effects include:

• Nausea, vomiting, stomach pain
• Diarrhea
• Loss of appetite

Serious side effects that require immediate medical attention:

• Allergic reaction: Hives, difficulty breathing, swelling of face, lips, tongue, or throat
• Pancreatitis: Severe pain in the upper stomach, spreading to the back, nausea, vomiting
• Signs of a thyroid tumor: Swelling or lump in the neck, trouble swallowing, hoarse voice, shortness of breath
• Low blood sugar: Headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, feeling jittery
• Kidney problems: Little or no urination, swelling in feet or ankles, feeling tired or short of breath

As with any medication, these lists are not exhaustive, and individuals may experience other side effects. Report any unusual or severe symptoms to a healthcare provider promptly.

5. Cost

The out-of-pocket costs for Ozempic and Trulicity can be high without insurance. Let’s find out more about their cost considerations.

Ozempic

The cost for Ozempic subcutaneous solution varies, with a common dosage of 2 mg/1.5 mL priced at around $994.86 for a supply of 1.5 milliliters. It's important to note that these prices are intended for cash-paying customers and may not apply to insurance plans.

To alleviate the financial burden for patients, Ozempic offers several savings options. The Drugs.com Discount Card can save customers up to 80%, making it a valuable resource at major pharmacies like Walgreens, CVS, and Walmart. Additionally, Ozempic provides a Savings Card for commercially insured patients, offering a $25 co-pay for a 30-day prescription with savings of up to $150 per fill. This offer is valid for up to 24 months after card activation.

Moreover, patient assistance programs such as the NovoCare Sharps Disposal Program and the Novo Nordisk Patient Assistance Program are available. These programs offer cost-free or discounted medicines and copay assistance for eligible individuals with low income or who are uninsured.

Trulicity

The cost of Trulicity subcutaneous solution, such as the 0.75 mg/0.5 mL dosage, is approximately $989.72 for a 2-milliliter supply. These prices are indicative for cash-paying customers and may not be compatible with insurance plans.

To address the financial aspect for patients, Trulicity offers various avenues for savings. The Drugs.com Discount Card provides substantial discounts, potentially saving customers up to 80% at major pharmacy chains. Additionally, Trulicity extends a Savings Card for commercially insured patients, allowing them to pay as little as $25 for up to 12 pens, with yearly savings capped at $1800.

Patient assistance programs, like the one offered by the Patient Access Network Foundation (PAN), cater to individuals with low income or lacking insurance coverage. These programs aim to provide eligible recipients with cost-free or discounted medications, including Trulicity.

Wrap Up

Ozempic and Trulicity are effective GLP-1 receptor agonists for type 2 diabetes treatment. However, clinical trial evidence shows Ozempic has superior efficacy in A1C and weight reduction compared to Trulicity over 40 weeks.

Despite similar side effect risks, Ozempic’s greater glycemic control and weight loss benefits make it the preferred first-choice injectable medication over Trulicity. Still, out-of-pocket costs may influence which drug a patient ultimately takes.

In consultation with a provider, patients can determine if once-weekly injected GLP-1 agonists are appropriate, with Ozempic favored as the more potent option.

FAQs on Ozempic and Trulicity

Does alcohol affect Trulicity?

Alcohol doesn't directly interact with Trulicity but can alter blood sugar levels. Limit alcohol intake to avoid this.

How long do the GLP-1 agonists Ozempic and Trulicity stay in the body?

Their half-lives are around 1 week, allowing for weekly dosing. Clearance may take 5 to 6 weeks after the last dose.

What injection sites can be used for Trulicity?

Common sites are the front of thighs, upper arms, or abdomen, at least 2 inches from the navel. Rotate sites weekly.

Can Trulicity be taken with other diabetes medications?

Yes, Trulicity can be combined with metformin, SGLT2 inhibitors, sulfonylureas, and other agents prescribed for type 2 diabetes management. With certain combinations, such as sulfonylureas, caution is needed to avoid hypoglycemia.