Scheen A J, Mathieu C
Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU Liège, Belgique.
Département d'Endocrinologie clinique et expérimentale, UZ Gasthuisberg, KU Leuven, Leuven, Belgique.
Rev Med Liege. 2018 Oct;73(10):526-532.
Xultophy® (IDegLira) is a fixed ratio combination of basal insulin degludec and glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide. Insulin degludec is characterized by an original mode of prolonged and continuous insulin diffusion after its subcutaneous injection. Thereby, it has a very long half-life, around 25 hours, and a better reproducibility from both a pharmacokinetic and pharmacodynamic point of view, with less hypoglycaemia, especially at night. Liraglutide is a well-known once-daily GLP-1 receptor agonist that showed a cardiovascular and renal protection in patients with type 2 diabetes at high cardiovascular risk. Both molecules exert complementary antihyperglycaemic effects, which allows a better glucose control, both in the fasting and postprandial states. IDegLira is more effective than another basal insulin regimen in reaching individualized glycated haemoglobin target, with a lower daily dose of insulin. It has a better tolerance profile, with a more favourable effect on body weight and less hypoglycaemia compared with a basal insulin and less gastrointestinal adverse effects when compared with liraglutide alone. Xultophy® is presented as a prefilled pen and is indicated in the management of type 2 diabetes not well controlled with basal insulin. The dose of IDegLira is progressively uptitrated, starting from 16 dose steps up to a maximum of 50 dose steps per day (corresponding to 50 IU insulin degludec and 1.8 mg liraglutide).
Xultophy®（德谷门冬双胰岛素）是基础胰岛素德谷胰岛素与胰高血糖素样肽-1（GLP-1）受体激动剂利拉鲁肽的固定比例复方制剂。德谷胰岛素的特点是皮下注射后具有独特的长效和持续胰岛素释放模式。因此，它具有很长的半衰期，约25小时，从药代动力学和药效学角度来看重现性更好，低血糖发生率更低，尤其是夜间低血糖。利拉鲁肽是一种广为人知的每日一次GLP-1受体激动剂，在心血管风险高的2型糖尿病患者中显示出心血管和肾脏保护作用。两种药物发挥互补的降糖作用，可在空腹和餐后状态下实现更好的血糖控制。与另一种基础胰岛素方案相比，德谷门冬双胰岛素在达到个体化糖化血红蛋白目标方面更有效，胰岛素日剂量更低。它具有更好的耐受性，与基础胰岛素相比对体重影响更有利，低血糖发生率更低，与单独使用利拉鲁肽相比胃肠道不良反应更少。Xultophy®以预填充笔的形式提供，适用于基础胰岛素治疗控制不佳的2型糖尿病患者的管理。德谷门冬双胰岛素的剂量从16个剂量步开始逐渐滴定，最高可达每天50个剂量步（相当于50 IU德谷胰岛素和1.8 mg利拉鲁肽）。
