Short answer: Both contain insulin degludec, injected once a day.12 Xultophy 100/3.6 adds liraglutide, a GLP-1 receptor agonist, for adults with type 2 diabetes at 10 to 50 units a day, and carries a boxed warning on thyroid C-cell tumors. Tresiba is insulin degludec alone, for people 1 year and older with diabetes, with no boxed warning. Their missed-dose rules differ.
| Xultophy 100/3.6 | Tresiba | |
|---|---|---|
| What is in it | Insulin degludec 100 units and liraglutide 3.6 mg per mL1 | Insulin degludec, U-100 or U-2002 |
| Approved for | Adults with type 2 diabetes1 | People 1 year and older with diabetes2 |
| When injected | Once daily at the same time, with or without food1 | Adults: once daily at any time. Children: the same time every day2 |
| Starting dose | 10 units if new to basal insulin and GLP-1; 16 units if on either1 | Type 2, new to insulin: 10 units. Type 1: about one-third to one-half of the total daily insulin2 |
| Dose changes | 2 units once or twice a week; 10 to 50 units, 50 the maximum1 | Increases 3 to 4 days apart2 |
| Common side effects | Nasopharyngitis 10%, headache 9%, nausea 8%, diarrhea 8%1 | Type 2: nasopharyngitis 12.9%, headache 8.8%, upper respiratory infection 8.4%2 |
| Missed dose | Resume with the next scheduled dose; if more than 3 days have passed, restart at the starting dose1 | Adults: inject during waking hours when noticed, at least 8 hours before the next dose. Children: call the provider2 |
| Boxed warning | Risk of thyroid C-cell tumors1 | None2 |
In one Xultophy trial, severe stomach and gut reactions were 0.8% on Xultophy vs 2.9% on liraglutide alone and 0.2% on insulin degludec alone. The label says these reactions may be more frequent at the start and ease within days or weeks.1 The label names insulin degludec as the comparator, not the Tresiba brand. Average weight gain on Tresiba over 52 weeks was 1.8 kg in type 1 and 3.0 kg in type 2 diabetes.2
Both list low blood sugar as the most common reaction, plus allergic reactions, low potassium, medication mix-ups, never sharing pens, and heart failure risk with thiazolidinediones.12 Xultophy adds the liraglutide warnings: thyroid C-cell tumors, so it is not used with a personal or family history of medullary thyroid carcinoma or MEN 2; pancreatitis; kidney injury from fluid loss; gallbladder disease; and breathing in stomach contents under anesthesia. More than 50 units a day can mean too much liraglutide.1 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Xultophy side effects, Tresiba side effects, the Xultophy and Tresiba dosing schedules, the Xultophy and Tresiba missed-dose pages, Soliqua vs Xultophy: how do the two insulin and GLP-1 pens differ? and Lantus vs Tresiba: how do the two long-acting insulins compare?.