Trulicity ® (dulaglutide)

This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information. Please refer to the link for full prescribing information: Trulicity Summary of Product Characteristics (SmPC)

Trulicity® (dulaglutide): Impaired Hepatic Function

Dulaglutide does not require dose adjustment in patients with impaired hepatic function.

Use of Dulaglutide in Patients With Impaired Hepatic Function

Clinical Pharmacology Study

In a clinical pharmacology study in patients with varying degrees of hepatic impairment, no clinically relevant change in the PK of dulaglutide was observed.1

Compared with subjects with normal hepatic function, dulaglutide systemic exposure decreased by

  • 23% in patients with mild hepatic impairment

  • 33% in patients with moderate hepatic impairment, and

  • 21% in patients with severe hepatic impairment.2

The Cmax was decreased by a similar magnitude.2

Use of Dulaglutide in Patients With NAFL/NASH

A post hoc integrated analysis of 4 AWARD studies, AWARD-1, -5, -8, and -9, was conducted to assess the effect of dulaglutide treatment compared with placebo treatment on the change in hepatic enzyme concentrations from baseline to 6 months in

  • the overall T2DM population, and

  • a subgroup population with NAFL/NASH.3

The NAFL/NASH subgroup population was defined using baseline ALT thresholds of

  • 30 IU/L for males, and

  • 19 IU/L for females.3

With the exception of GGT in patients in the placebo group in the overall T2DM population, an improvement in hepatic enzyme concentrations was observed in the

  • overall T2DM population, and

  • NAFL/NASH subgroup population (Table 1).3

Table 1. Change in Hepatic Enzyme Concentrations From Baseline to 6 Months in the Overall T2DM Population and the NAFL/NASH Subgroup Population - Post Hoc Analysis3

Hepatic Enzyme, IU/La

Overall T2DM Population
DU 1.5 mg

Overall T2DM Population

Overall T2DM Population
Treatment Difference

Subgroup Population
DU 1.5 mg

Subgroup Population

Subgroup Population
Treatment Difference




(-2.8, -0.6)c



(-3.9, -0.3)c




(-2.1, -0.1)c



(-2.0, 1.1)




(-12.4, -0.8)c



(-11.8, 4.2)

Abbreviations: ALT = alanine transaminase; AST = aspartate transaminase; DU = dulaglutide; GGT = gamma-glutamyl transpeptidase; ITT = intention-to-treat; IU = international unit; LOCF = last observation carried forward; LSM = least squares mean; NAFL = nonalcoholic fatty liver; NASH = nonalcoholic steatohepatitis; PBO = placebo; T2DM = type 2 diabetes mellitus.

a Data presented as LSM or LSM (95% CI); ITT without postrescue values, parameters analyzed using analysis of covariance (LOCF).

b p<.001 vs baseline.

c p<.05 vs placebo.

d p<.05 vs baseline.


1. Trulicity [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.

2. Data on file, Eli Lilly and Company and/or one of its subsidiaries.

3. Cusi K, Sattar N, García-Pérez LE, et al. Dulaglutide decreases plasma aminotransferases in people with type 2 diabetes in a pattern consistent with liver fat reduction: a post hoc analysis of the AWARD programme. Diabet Med. 2018;35(10):1434-1439.


ALT = alanine aminotransferase

AWARD = Assessment of Weekly AdministRation of LY2189265 in Diabetes

Cmax = maximum serum concentration

GGT = gamma-glutamyl transpeptidase

IU = international unit

NAFL = nonalcoholic fatty liver

NASH = nonalcoholic steatohepatitis

PK = pharmacokinetic

T2DM = type 2 diabetes mellitus

Date of Last Review: October 22, 2018

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