Le medicament du mois. Combinaison en proportion fixe insuline basale degludec-liraglutide (Xultophy(R)).

Xultophy(R) (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(R) 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).