Trulicity vs Ozempic

The Trulicity label covers glycaemic control in type 2 diabetes in adults and paediatric patients aged 10 and older, and reducing the risk of major adverse cardiovascular events in adults who have type 2 diabetes with established cardiovascular disease or multiple risk factors. The Ozempic label covers glycaemic control in adults, the same cardiovascular indication in adults with established disease, and a third indication for kidney outcomes in chronic kidney disease.

Semaglutide does hold a weight management approval in the United States, under the separate name Wegovy. Dulaglutide holds no such approval at all: there is no second brand, no second label, and nothing in the approved document that describes it for weight.

Both carry the boxed warning about the risk of thyroid C-cell tumours observed in rodents, and both are contraindicated in anyone with a personal or family history of medullary thyroid carcinoma or with multiple endocrine neoplasia syndrome type 2. Repeated word for word across products of one class, that is a class warning rather than a statement about either product.

Below the box the lists run close: acute pancreatitis, hypoglycaemia when combined with insulin or an insulin secretagogue, kidney injury, serious hypersensitivity. The Ozempic label adds diabetic retinopathy complications and an instruction that a pen must never be shared between patients.

Trulicity starts at 0.75 mg once weekly, may go to 1.5 mg after four weeks, and can be escalated further; it is supplied in single-dose pens of 0.75 mg, 1.5 mg, 3 mg and 4.5 mg. Ozempic starts at 0.25 mg once weekly, moves to 0.5 mg after four weeks, and can go to 1 mg and then 2 mg.

The numbers are not comparable between products: milligrams of dulaglutide and milligrams of semaglutide are different substances, and neither label converts one into the other.

A missed dose is handled differently, and this is a practical difference rather than a pharmacological one. Trulicity may be taken as soon as possible if at least 72 hours remain before the next scheduled dose. Ozempic may be taken within 5 days of the missed dose.

Both labels use a 5 percent threshold. Trulicity lists nausea, diarrhoea, vomiting, abdominal pain and decreased appetite. Ozempic lists nausea, vomiting, diarrhoea, abdominal pain and constipation.

The difference is at the end of each list: decreased appetite appears for one, constipation for the other. Both lists come from separate trials in different populations, so this is not a measured difference between the two products.

Trulicity is approved under a biologics licence application rather than a new drug application, because dulaglutide is a protein. That is why there is no generic dulaglutide and will not be one: copies of biologics reach the market as biosimilars, under their own approvals.

Semaglutide is approved under a new drug application. Neither route says anything about how well either medication works; it determines what a copy of it would have to be called and how it would be approved.