Back

Latest News

Resource Spotlight: Tirzepatide and Upcoming Medications

August 29, 2023
 

Written by Holly Wingate

This article was written and researched by a CSHP student member for Interactions, our biweekly newsletter. Crafting these pieces not only helps students gain in-depth knowledge of specific conditions, treatments, and resources, it also helps them hone their skills in research, critical appraisal, evaluation, synthesis, and writing – all of which will serve them well in clinical practice. The Professional Practice Team works with the student to select topics that are of interest and utility to both the student and to you, the reader. We hope you enjoy this piece by one of our future colleagues! Let us know what you think: If you would like to provide any comments or constructive feedback for our students, please email us at practice@cshp.ca

Background

Tirzepatide (Mounjaro) is a recently approved selective glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist (RA).2 Tirzepatide has shown benefits for achieving glycemic control, including reductions in HbA1C and blood glucose control, with varying degrees of weight loss and without hypoglycemia, across various SUPRASS trials.1 This was seen across trials as monotherapy, in combination with metformin, an SGLT2i, or basal insulin, and through comparisons with placebo, semaglutide, and basal insulin.1 It is indicated as a once-weekly therapy as an adjunct to diet and exercise to improve glycemic control for the treatment of adult patients with type 2 diabetes mellitus (T2DM), and there are trials currently underway for obesity (SURMOUNT trials) and heart failure with preserved ejection fraction (HFpEF) (SUMMIT trial). This “Resource Spotlight” contains tools for staying up to date with upcoming therapies as health care professionals, as well as tirzepatide specific resources. To learn more about tirzepatide and its place in Type 2 Diabetes treatment, check out the Canadian Society of Hospital Pharmacists (CSHP) recent Clinical Pearl article on Tirzepatide here.

 

Upcoming medications resources

Canadian Journal of Health Technologies (CJHT)
The CJHT is an open-access online scientific and policy journal that is published by the Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH is a not-for-profit organization which is funded by Canada’s federal, provincial and territorial governments. It provides health care decision-makers with independent evidence, advice, and recommendations to help inform policy and practice decisions. Each month, the CJHT produces articles such as horizon scans, reimbursement reviews, and health technology assessments. For example, the current May 2023 issue has 3 reimbursement reviews, 1 horizon scan, and 2 health technology reviews published at the time of writing. Their horizon scans describe new medications, tests, or treatment considerations for differing conditions, and are useful for staying up to date on upcoming treatments which may affect practice. Click here to see the most recent horizon scan on Objective Assessment System for Cognitive Function.

ClinicalTrials.gov
ClinicalTrials.gov is a web-based resource maintained by the National Library of Medicine (NLM) and the National Institutes of Health (NIH), which provides open access to information on publicly and privately supported clinical studies under a wide range of diseases. The website features the Find Studies tab which enables the reader to See Studies by Topic, which then provides a list of all systems with trials currently underway or completed, such as Behavioural and Mental Disorders, Eye Diseases, Infections, Neoplasms, Substance Related Disorders, Wound and Injuries, and more. You can choose which system to look into and sift through trials based on the specific condition listed. For new medications or those with expanded indications being trialed, using raw trial data can help form independent opinions of the indication and clinical significance of the trial when looking at the population included, inclusion and exclusion criteria, duration, primary outcomes and results. Click here to access the Search by Topic resource.

Tirzepatide resources 

American Diabetes Association: Standards of Care in Diabetes
In this supplemental PDF from the ADA’s guidelines, tirzepatide’s place in the treatment of type 2 diabetes is described. Under the Journal of Clinical and Applied Research, the ADA aims to promote better patient care by serving the expanded needs of all health professionals committed to the care of patients with diabetes. This guideline is highlighted as there is no Canadian data for tirzepatide at the time of writing, therefore extrapolating the use of tirzepatide to Canadian patients, as well as its place in diabetes treatment, is required. On page 155 of this document, the flow-chart ‘Use of Glucose-Lowering Medications in the Management of Type 2 Diabetes’ provides a comprehensive approach to determining which patient may have the most benefit from Tirzepatide. Table 9.2 on page 156 provides detailed comparison of anti-hyperglycemic medications that may be useful for deciding which medication to choose based on patient-specific characteristics and comorbidities (such as CKD, HF, or sensitivity to side effects). Click here to see the Use of Glucose-Lowering Medications flow-chart, and here for Table 9.2.

CADTH Horizon Scan: Tirzepatide 
This CJHT horizon scan was published in their April 2022 issue before tirzepatide’s eventual approval in November of 2022. This resource is highlighted due to its comprehensiveness in background and trial information, as well as its references listed. The SURPASS trials are described in comparison with each other, and then in more comprehensive detail on their own, offering a complete look at each trial specifically. While not described in detail, all SURMOUNT and SUMMIT trial reference links are included as well. Click here to read the horizon scan on Tirzepatide for Type 2 Diabetes Mellitus.

Tirzepatide Review Articles
As tirzepatide is a fairly new drug, especially in Canada, there are little guideline recommendations to follow; when looking at the ADA guidelines, although able to decipher where tirzepatide falls into the classes of T2DM medications, it is not clearly laid out when to initiate the medication, and this can only be extrapolated to a certain extent for Canadian patients. Below are some useful review articles when trying to determine which patient tirzepatide is most ideal in, and to summarize tirzepatides characteristics:

  1. Lingvay I, Cheng AY, Levine JA, Gomez-Valderas E, Allen SE, Ranta K, et al. Achievement of glycaemic targets with weight loss and without hypoglycaemia in type 2 diabetes with the once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist tirzepatide: A post hoc analysis of the SURPASS-1 to -5 studies. Diabetes Obes Metab. 2023;25(4):965-974. doi:10.1111/dom.14943. This post hoc analysis only reviews the SURPASS 1-5 trials, thoroughly compares the trial designs to each other including participants and end points. This article is included as it is a good starting point to form one's own opinions on tirzepatides benefits. The full article can be found here.
  2. Chavda VP, Ajabiya J, Teli D, Bojarska J, Apostolopoulos V. Tirzepatide, a New Era of Dual-Targeted Treatment for Diabetes and Obesity: A Mini-Review. Molecules. 2022;27(13):4315. Published 2022 Jul 5. doi:10.3390/molecules27134315. This article presents the key characteristics of tirzepatide in terms of synthesis, structure, and activity, bearing in mind its advantages and shortcomings. Authors also briefly review the key clinical trials. Click here to review the article.
  3. Gallwitz B. Clinical perspectives on the use of the GIP/GLP-1 receptor agonist tirzepatide for the treatment of type-2 diabetes and obesity. Front Endocrinol (Lausanne). 2022;13:1004044. Published 2022 Oct 13. doi:10.3389/fendo.2022.1004044. This article summarizes the current clinical study programs (SURPASS and SURMOUNT) and the respective outcomes and highlights further potential indications for tirzepatide in the treatment of obesity and potentially other comorbidities of T2DM. It also describes the clinical use and benefits of dual incretin agonists. Click here to review the article.
  4. Karagiannis T, Avgerinos I, Liakos A, et al. Management of type 2 diabetes with the dual GIP/GLP-1 receptor agonist tirzepatide: a systematic review and meta-analysis. Diabetologia. 2022;65(8):1251-1261. doi:10.1007/s00125-022-05715-4. This systemic review assesses efficacy and safety of tirzepatide for T2DM with different comparators. While many systemic reviews of tirzepatide exist, this specific article has a highly useful graphic to describe the change in HbA1C with different doses in comparison to other GLP-1 RAs, insulin, and placebo; this graphic may be useful for demonstrating HbA1C benefits when describing tirzepatide to patients. Click here to review the article.

References

  1. MOUNJARO (Tirzepatide) Product Monograph. Toronto (ON): Eli Lilly Canada Inc. 2022 Nov 23
  2. Lingvay I, Cheng AY, Levine JA, Gomez-Valderas E, Allen SE, Ranta K, Torcello-Gomez A, Thieu VT. Achievement of glycaemic targets with weight loss and without hypoglycaemia in type 2 diabetes with the once-weekly glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist tirzepatide: A post hoc analysis of the SURPASS-1 to -5 studies. Diabetes Obes Metab. 2023;25(4):965-974. doi:10.1111/dom.14943