Semaglutide Reduces CV Events in High-Risk Patients with Type 2 Diabetes Mellitus
Am Fam Physician. 2017 Mar 15;95(6):396.
Does semaglutide reduce the likelihood of subsequent cardiovascular (CV) events in patients with type 2 diabetes mellitus and known CV or chronic kidney disease?
Semaglutide significantly reduced the composite outcome of CV death, nonfatal myocardial infarction, and nonfatal stroke (number needed to treat [NNT] = 43 over 2.1 years). It was generally well tolerated, and it reduced body weight by approximately 6.4 to 9.5 lb (2.9 to 4.3 kg). Although pricing is not available, similar drugs are priced at approximately $700 per month in the United States. One harm was a small increase in complications of retinopathy, especially vitreous hemorrhage. It is important to remember that this was a very high-risk group with a mean age of 65 years; most had known ischemic heart disease. (Level of Evidence = 1a)
Semaglutide is a glucagon-like peptide-1 analogue that has a long half-life, allowing once-weekly administration as a subcutaneous injection. This study was designed as a noninferiority trial to demonstrate that the drug does not increase the risk of adverse CV events. The authors recruited a high-risk group of patients: 50 years or older with known CV disease or chronic kidney disease, or 60 years or older with at least one CV risk factor. The authors screened 4,346 patients for inclusion and ultimately included 3,297 patients who were randomized to receive semaglutide or matching placebo injections once weekly.
Patients were started at a dosage of 0.25 mg per week for four weeks, and then half of those in the intervention group were escalated to a final dosage of 0.5 mg per week and the other half to a final maintenance dosage of 1.0 mg per week. Groups were balanced at baseline with a mean age of 65 years and a mean duration of type 2 diabetes of 14 years; 61% were men. Most (93%) had hypertension, and 60% had documented ischemic heart disease. Patients were followed for a median of 2.1 years, and analysis was by intention to treat.
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