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Semaglutide outperforms dulaglutide across all strata of HbA1c
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ORLANDO, Fla. — Semaglutide yielded greater HbA1c and weight reductions compared with dulaglutide across all levels of HbA1c, according to findings from a post-hoc analysis of the SUSTAIN 7 study.
“The SUSTAIN 7 study saw significant differences [in HbA1c reduction] favoring semaglutide at both the low and high doses, and also found significant differences in the reduction of body weight,” Richard E. Pratley, MD, medical director of the Florida Hospital Diabetes Institute, said during a presentation here. “We wondered: What would the efficacy of these drugs look like across the spectrum of baseline HbA1c subgroups?”
In the present study, Pratley and colleagues evaluated 1,192 patients with type 2 diabetes, grouped into the following baseline HbA1c strata: less than 7.5%; 7.5% to 8%; 8% to 8.5%; 8.5% to 9%; and more than 9%.
The 40-week study assessed once-weekly subcutaneous semaglutide (Ozempic, Novo Nordisk) 0.5 mg vs. dulaglutide (Trulicity, Lilly) 0.75 mg and semaglutide 1 mg vs. dulaglutide 1.5 mg by baseline HbA1c category. Among the parameters analyzed were changes in HbA1c, changes in fasting plasma glucose, 7-point self-monitoring blood glucose and body weight. Researchers evaluated HbA1c responders for targets of less than 6.5%, the American Diabetes Association target of less than 7%, and less than 8%.
The treatment subgroups were similar in age and diabetes duration.
The researchers found that, at 40 weeks, patients in the semaglutide group showed reductions in HbA1c and body weight that were comparable or superior to dulaglutide across subgroups (P for interaction: HbA1c, P = .02; body weight, P > .05). The estimated treatment effects were comparable or favored semaglutide. Additionally, more of the patients with baseline HbA1c greater than 9% attained HbA1c goals with semaglutide vs. dulaglutide, Pratley said.
“What we saw, in patients with baseline HbA1c above 9%, were 32% and 41% in the low and high doses [respectively] achieving the target of less than 6.5% with semaglutide; for the target of less than 7%, 44% and 55% of patients on [low and high] semaglutide [doses, respectively] achieved that target,” Pratley said. “For the measure of less than 8%, 64% and 88% of patients starting with HbA1c higher than 9% achieved this goal.”
Adverse events were similar, with slightly more adverse events at higher doses of both medications. Serious adverse events leading to discontinuation were slightly higher with semaglutide. Gastrointestinal events were higher in the lower dose of semaglutide vs. dulaglutide.
Pratley discussed the possible mechanism of the weight loss achieved with semaglutide vs. dulaglutide.
“This difference has been consistently seen across the clinical trials with semaglutide and is not limited to this study,” he said. “The general thinking is that it is related to greater efficacy at the GLP-1 receptor, and perhaps the differences that are seen in this particular trial have to do with the size of the molecule.” – by Jennifer Byrne
Reference:
Pratley RE, et al. 122-OR. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Disclosures: Pratley reports he has various financial ties to AstraZeneca, Boehringer Ingelheim, Eisai, Eli Lilly and Co., GlaxoSmithKline, Janssen Pharmaceuticals, Lexicon Pharmaceuticals, Ligand Pharmaceuticals, Merck & Co., Novo Nordisk, Pfizer, Sanofi-Aventis and Takeda Development Center Americas. Please see the abstract for a list of all other relevant financial disclosures.