TABLE 1.

Overview of Once-Weekly GLP-1 RAs

	Exenatide ER	Dulaglutide	Semaglutide
Indication
Adjunct to diet and exercise to improve glycemic control in adults with T2DM	×	×	×
Limitations of use
Not recommended as first-line therapy for patients inadequately controlled on diet and exercise	×	×	×
Should not be used to treat T1DM or DKA	×	×	×
Use with insulin not studied and not recommended
Has not been studied in patients with a history of pancreatitis	×	×	×
Not for patients with preexisting severe gastrointestinal disease	×	×
Dosage and administration	2 mg SC QW	0.75 mg SC QW; can increase to 1.5 mg SC QW	0.25 mg SC QW; can be increased at 4-week intervals to 0.5 mg QW, then 1 mg QW
Contraindications
Patients with personal or family history of medullary thyroid carcinoma	×	×	×
Patients with multiple endocrine neoplasia syndrome type 2	×	×	×
Prior or serious hypersensitivity reaction to any of the product components	×	×	×
Warnings and precautions
Black-boxed warning: risk of thyroid C-cell tumors	×	×	×
Pancreatitis	×	×	×
When used in combination with an insulin secretagogue (e.g., a sulfonylurea) or insulin, consider lowering the dose of the secretagogue or insulin to reduce the risk of hypoglycemia	×	×	×
Renal impairment/acute kidney injury	×	×	×
Not recommended in patients with severe gastrointestinal disease (e.g., gastroparesis)	×	×
Immunogenicity (antibodies)	×
Hypersensitivity reactions	×	×	×
Postmarketing reports of serious injection-site reactions with or without subcutaneous nodules	×
No clinical studies establishing conclusive evidence of macrovascular risk reduction	×	×	×
Patients with history of diabetic retinopathy should be monitored			×

DKA = diabetic ketoacidosis; ER = extended-release; GLP-1 RA = glucagon-like peptide-1 receptor agonist; QW = once weekly; SC = subcutaneous; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus.