Semaglutide is an option when the use of a GLP-1 analogue is considered. This will usually be if drug therapy with metformin is insufficient to control type 2 diabetes. In the open-label trials the absolute differences between semaglutide and exenatide4 and dulaglutide8 were small, but they met the criteria for statistical superiority for the reductions in HbA1c and body weight. While increasing the dose of semaglutide to 1 mg will cause a slightly greater reduction of HbA1c it will also increase adverse effects.
Changes in the concentrations of HbA1c are a surrogate outcome in type 2 diabetes. It is too early to assess all the long-term clinical outcomes, however semaglutide might have some benefit in patients with a high risk of cardiovascular events. SUSTAIN 6 enrolled 3297 patients with cardiovascular disease, chronic heart failure or chronic kidney disease. These patients had an average HbA1c concentration of 72 mmol/mol (8.7%). They were randomised to semaglutide (0.5 mg or 1 mg) or a placebo. After a median follow-up of 2.1 years there had been a cardiovascular event in 6.6% of the semaglutide group and 8.9% of the placebo group. However, deaths from cardiovascular causes were similar (2.7% vs 2.8%) in both groups. The patients injecting semaglutide also had more complications from diabetic retinopathy (3.0 vs 1.8%).7
An oral formulation of semaglutide has been developed. If this is approved for use in Australia, it may give semaglutide an advantage over the other GLP-1 analogues.
🅃🅃 manufacturer provided additional useful information
The Transparency Score is explained in New drugs: transparency, Vol 37 No 1, Aust Prescr 2014;37:27.
At the time the comment was prepared, information about this drug was available on the websites of the Food and Drug Administration in the USA, and the European Medicines Agency.