Effects of dose escalating liraglutide from 1.2 to 1.8 mg in clinical practice: a case-control study.
OBJECTIVE
Randomized trials show that liraglutide 1.8 mg is more effective than 1.2 mg in reducing HbA1c, but dose escalation is neither routinely considered nor recommended by some guidelines. We report real world data on the effects of dose-escalating liraglutide from 1.2 to 1.8 mg.


METHODS
In a pseudo-prospective, case-control study, patients who underwent liraglutide dose escalation to 1.8 mg for not having met individualized targets while on the 1.2 mg dose (n = 52) were compared to matched patients who remained on 1.2 mg (n = 52) for having shown good response, as defined by the patient's own diabetologist. HbA1c was recorded at ≤6-month intervals until the end of observation.


RESULTS
The two groups were matched for all clinical characteristics, including baseline HbA1c (8.5 %). During a 12-month follow-up, patients who remained on liraglutide 1.2 mg showed a maximal HbA1c reduction of 1.29 ± 0.15 %. Patients who escalated to 1.8 mg showed a lower HbA1c reduction during therapy with 1.2 mg than controls (0.58 ± 0.16 %; p = 0.0017). Escalation to 1.8 mg resulted in a further HbA1c reduction of 0.62 ± 0.17 %. During a total 18-month follow-up, patients who escalated to 1.8 mg showed a total maximal HbA1c reduction of 0.84 ± 0.22 %. At the end of the observation, HbA1c was 7.54 ± 0.17 % in patients who remained on 1.2 mg and 7.92 ± 0.21 in patients who escalated to 1.8 mg (p = 0.13). Escalation to 1.8 mg also helped further body weight reduction.


CONCLUSIONS
Escalating liraglutide dose to 1.8 mg in patients who responded less than expected to 1.2 mg helps in reducing HbA1c and reaching therapeutic targets.
Department of Medicine, University of Padova, V. Giustiniani, 2, 35128, Padua, Italy.
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Rigato
Department of Medicine, University of Padova, V. Giustiniani, 2, 35128, Padua, Italy.
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Avogaro
Department of Medicine, University of Padova, V. Giustiniani, 2, 35128, Padua, Italy. gianpaolofadini@hotmail.com.
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Fadini
D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000494:pharmacology*; D000069450:Liraglutide / Q000008:administration & dosage* / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069450:Liraglutide; C517652:hemoglobin A1c protein, human
Durability; Medications; Therapy; Type 2 diabetes