Division of Practical Pharmacy, Nihon Pharmaceutical University, Saitama, Japan.
Pharmaceutical Department, Ina Hospital, Saitama, Japan.
Drug Discov Ther. 2024 Nov 15;18(5):323-324. doi: 10.5582/ddt.2024.01061. Epub 2024 Oct 28.
The case reports a woman in her 70s, with type 2 diabetes and chronic kidney disease in G4 stage. The patient had elevated HbA1c, and she was switched from linagliptin, a dipeptidyl peptidase 4 inhibitor, to dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). Thereafter, the HbA1c level decreased; however, since the dulaglutide supply became a problem, the patient was switched to tirzepatide, a glucose-dependent insulinotropic polypeptide (GIP)/GLP-1RA. To date, no clinical studies have evaluated the efficacy and safety of switching from GLP-1RA to GIP/GLP-1RA, but we report this case because efficacy was observed in this patient. The therapeutic effects after switching to tirzepatide included decrease in HbA1c, increase in eGFR, and decrease in BUN, when compared to when dulaglutide was used. A change from dulaglutide to tirzepatide, could inhibit renal impairment progression and improve renal function.
病例报告了一位 70 多岁的女性，患有 2 型糖尿病和 G4 期慢性肾脏病。患者的糖化血红蛋白（HbA1c）升高，她被从二肽基肽酶 4 抑制剂利拉利汀（linagliptin）转换为胰高血糖素样肽-1 受体激动剂（GLP-1RA）度拉糖肽（dulaglutide）。此后，HbA1c 水平下降；然而，由于度拉糖肽供应出现问题，患者转而使用葡萄糖依赖性胰岛素促泌多肽（GIP）/GLP-1RA 替西帕肽（tirzepatide）。迄今为止，尚无临床研究评估从 GLP-1RA 转换为 GIP/GLP-1RA 的疗效和安全性，但我们报告了这个病例，因为在该患者中观察到了疗效。与使用度拉糖肽相比，换用替西帕肽后包括糖化血红蛋白（HbA1c）下降、估算肾小球滤过率（eGFR）增加和血尿素氮（BUN）下降。从度拉糖肽转换为替西帕肽可能会抑制肾功能损害进展并改善肾功能。
