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SUSTAIN 10: Semaglutide tops liraglutide providing support for changing prescribing patterns

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Among a cohort of adults with type 2 diabetes already using oral medications, those assigned to add a weekly injection of 1 mg semaglutide vs. 1.2 mg liraglutide experienced larger decreases in HbA1c and body weight, according to findings from the SUSTAIN 10 trial presented at the European Association for the Study of Diabetes annual meeting and published simultaneously in Diabetes & Metabolism.

Matthew S. Capehorn

“I personally see this as a very valuable study in the context of real-world practice,” Matthew S. Capehorn, BMedSci, MBChB, clinical manager of the Rotherham Institute for Obesity (RIO), part-time medical director of LighterLife and partner at Clifton Medical Centre in the U.K., told Endocrine Today. “We have previously had other studies within the SUSTAIN program that have compared semaglutide against other competitor drugs, but we cannot get away from the fact that one of the most commonly prescribed GLP-1 analogues across Europe is liraglutide — and the most commonly prescribed dose, whether for reasons of reimbursement or perceived cost-effectiveness, is 1.2 mg once daily — and so we needed evidence to help clinicians to consider using this newer agent rather than stick with those that are tried and tested.”

Capehorn and colleagues examined changes in HbA1c and body weight following a once-weekly regimen of 1 mg semaglutide (Ozempic, Novo Nordisk) or 1.2 mg liraglutide (Victoza, Novo Nordisk) among 577 adults (mean age, 59.5 years; 43.3% women; mean HbA1c, 8.2%; mean body weight, 96.9 kg) with type 2 diabetes who were already using up to three oral medications for diabetes. The researchers randomly assigned the participants equally to one of the two regimens and followed them for 30 weeks. The regimens were modeled on what the researchers wrote were the most frequently prescribed doses of each medication.

HbA1c effects

Participants assigned semaglutide experienced a mean 1.7% decrease in HbA1c at 30 weeks vs. a mean 1% decrease for those assigned liraglutide (P < .0001). The semaglutide group also had a mean fasting plasma glucose level 1.24 mmol/mol lower than that for the liraglutide group at 30 weeks based on estimated treatment difference (95% CI, –1.54 to –0.93). In addition, those taking semaglutide experienced a mean 3 mmol/L decrease in 7-point self-monitoring blood glucose profile at 30 weeks compared with a mean 2.1 mmol/L decrease for those taking liraglutide (P < .0001). Those taking semaglutide had a mean SMBG increment 0.53 mmol/mol lower than that for the liraglutide group at 30 weeks based on estimated treatment difference (95% CI, –0.77 to –0.28).

 

Among a cohort of adults with type 2 diabetes already using oral medications, those assigned to add a weekly injection of 1 mg semaglutide vs. 1.2 mg liraglutide experienced larger decreases in HbA1c and body weight.

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At 30 weeks, 80% of those taking semaglutide reduced HbA1c below the 7% threshold vs. 46% of those taking liraglutide (P < .0001). Additionally, 58% of those taking semaglutide reduced HbA1c below the 6.5% threshold at 30 weeks vs. 25% of those taking liraglutide (P < .0001). Of those taking semaglutide, 83% had an HbA1c decrease of at least 1% vs. 48% of those taking liraglutide (P < .0001).

Weight-loss effects

Those taking semaglutide lost an average of 5.8 kg at 30 weeks while those taking liraglutide lost an average of 1.9 kg (P < .0001). At 30 weeks, 73% of those taking semaglutide and 34% of those taking liraglutide lost at least 3% of their baseline weight (P < .0001). More than half of those taking semaglutide (56%) and 18% of those taking liraglutide lost at least 5% of their baseline weight (P < .0001). In addition, 19% of those taking semaglutide and 4% of those taking liraglutide lost at least 10% of their weight (P < .0001).

More than three-quarters of those taking semaglutide (76%) had not gained weight and reached an HbA1c of below 7% by 30 weeks while 37% of those taking liraglutide met these criteria (P < .0001). Additionally, 62% of those taking semaglutide and 21% of those taking liraglutide lost at least 3% of their baseline weight and experienced at least a 1% decrease in HbA1c (P < .0001), 50% of those taking semaglutide and 12% of those taking liraglutide lost at least 5% of their baseline weight and experienced at least a 1% decrease in HbA1c (P < .0001), and 17% of those taking semaglutide and 4% of those taking liraglutide lost at least 10% of their baseline weight and experienced at least a 1% decrease in HbA1c (P < .0001).

There were 758 treatment-emergent adverse events among those taking semaglutide, particularly gastrointestinal disorders (n = 315). By contrast, there were 691 treatment-emergent adverse events among those taking liraglutide, including 219 gastrointestinal disorders. The researchers noted that there were 33 participants taking semaglutide and 19 participants taking liraglutide who had to stop taking the medication due to adverse events.

“It seems clear that, in practice, clinicians may have the dilemma as to whether to continue to prescribe 1.2 mg once-daily liraglutide, or consider 1 mg once-weekly semaglutide,” Capehorn said. “SUSTAIN 10 offers the evidence for clinicians facing this prescribing dilemma. Semaglutide is superior to liraglutide for HbA1c and body weight reduction, and with a similar overall safety profile, accepting slightly more initial gastrointestinal side effects. Given the cost of semaglutide, it seems a clear choice that prescribers should consider once-weekly semaglutide over once-daily liraglutide.” – by Phil Neuffer

References:

Capehorn MS. OP 53. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.

Capehorn MS, et al. Diabetes Metab. 2019;doi:10.1016/j.diabet.2019.101117.

For more information:

Matthew S. Capehorn, BMedSci, MBCh B, can be reached at mcapehorn@yahoo.co.uk.

Disclosures: Novo Nordisk funded this study. Capehorn reports he is a member of the Association for the Study of Obesity and the Primary Care Academy of Diabetes Specialists and has received advisory board support, research support and speaker fees from Boehringer Ingelheim/Lilly and Novo Nordisk; advisory board support and speaker fees from Janssen; research support from Abbott, GlaxoSmithKline, Leo and Novartis; and advisory board support from Merck Sharp & Dohme. Please see the study for all other authors’ relevant financial disclosures.