Rx Shorts: Long-acting Insulin Confusion

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The long-acting insulin family has added a few new members over the last couple of years. As these seminovel insulin products have made their way to preferred status on many prescription drug formularies, many patients are now being forced to change from the old standards, Lantus and Levemir. Which new product might be best for which patient? A quick look at some key differences may help prescribers decide.

• Basaglar (insulin glargine)– Basaglar is essentially Lilly’s version of Lantus (made by Sanofi-Aventis). The only difference from Lantus is the Lilly KwikPen delivery system also found on other Lilly short-acting insulins like Humulin and Humalog. Basaglar dose should be the same as Lantus because it is the same drug at the same concentration.
• Toujeo (insulin glargine) – Toujeo also is a glargine product but supplied in a 300 U/mL pen. Logically, the higher concentration is better for patients who require larger doses of insulin (80 units of Lantus equates to 0.8 mL versus just 0.27 mL with Toujeo). What’s more, a single Toujeo pen is stable at room temperature for 42 days once in use compared to only 28 days with Lantus.
• Tresiba (insulin degludec) – Tresiba has a niche-it is truly a once-daily insulin with a duration of action up to 42 hours. Due to its long half-life, Tresiba is optimal for patients who occasionally miss doses or deviate from their normal injection time (eg, busy professionals, non-adherent patients, patients with impaired memory, etc.). Also patients who struggle with high blood sugar late in the day after morning injections or in the morning after evening injections, may find that Tresiba offers longer-lasting control thus more consistent A1c values. Tresiba is made by Novo-Nordisk (who also produces Levemir) and is available as a 100 U/mL and 200 U/mL pen that uses the Novo-Nordisk FlexTouch delivery system).

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Rx Shortsprovides PCPs with brief, timely updates on a wide variety of matters surrounding prescription drugs. Label changes, supplemental NDAs, FDA advisories, recalls, black box additions, patent expirations, off label uses-the topics will be as varied as the pharma news itself. Author Matthew Baker, PharmD, of Lufkin, TX, serves as the Patient Care eyes and ears in the pharmaceutical realm.