Missed Doses, Missed Opportunities: Readmission Due to GLP-1RA Interruption Inspires Algorithms to Improve Reinitiation of Therapy at Discharge

Objectives: The objectives of this case report are to describe the hospitalization of a patient due to a preventable adverse event caused by dulaglutide after restarting therapy following a previous hospitalization where it was held, and to summarize suggested guidance on managing glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) during transitions of care. Case Summary: A 70-year-old female was admitted with epigastric pain that began a week before admission. One month prior, she was hospitalized for chest pain and diagnosed with a left anterior descending artery occlusion, requiring a 3-vessel CABG. The pharmacy transitions of care service discovered that during her prior stay, she missed 2 doses of dulaglutide and resumed it at the previous dose of 4.5 mg on discharge. After a comprehensive workup, she was diagnosed with gastritis. Her pain improved over the course of 4 days, and she was discharged with instructions to hold the dulaglutide upon discharge and consult her primary care physician for re-titration. Conclusion: This case highlights the need for clearer guidance on the reinitiation of GLP-1 RAs after missed doses while in the hospital. Using available literature, algorithms were generated to provide recommendations when more than 1 weekly GLP-1 RA dose is missed. These algorithms provide guidance for providers during transitions of care and may be studied prospectively to validate their application in a real-world setting.