Episode #3: The new GLP-1 kid on the block - Semaglutide!

Disgruntled Dan’s Conclusions:

1. Semaglutide reduces the risk of nonfatal stroke (NNT 97 for 2.1 years), new or worsening nephropathy (NNT 43 over 2.1 years), and revascularization. Yes – there was a reduction in the composite MACE outcomes, but this was primarily driven by the results from nonfatal strokes.
2. Use with caution in patients that currently have retinopathies – Semaglutide may worsen and/or cause retinopathies and the exact cause is currently unknown.
3. Once weekly dosing – convenient for the patient.
4. Start low and go slow, it is a once weekly injection. Due to the long half life it is recommended you start at 0.25mg x 4 weeks THEN 0.5mg x 4 weeks THEN increase to max dose of 1mg.
5. Cost ~$700 for a 4-6 week supply without insurance.
6. It is a new drug. We do not have much experience with it. So I am always cautiously optimistic but I will generally choose options that we have a bit more real world data with before jumping to this. In reality it comes down to that patient sitting in front of you. Remember to keep it patient centred!

References

1. Marso, S. P. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N. Engl. J. Med. 375, 1834–1844 (2016).
2. Fda, Cder & buckmans. Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry. (2016).
3. Sorli, C. et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. lancet. Diabetes Endocrinol. 5, 251–260 (2017).
4. Dungan, K. & DeSantis, A. Glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes mellitus - UpToDate. Available at: https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?search=glp 1&source=search_result&selectedTitle=1~106&usage_type=default&display_rank=1. (Accessed: 6th May 2018)
5. Guyatt, G., Rennie, D., Meade, M. & Cook, D. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed | JAMAevidence | McGraw-Hill Medical. Available at: https://jamaevidence.mhmedical.com/Book.aspx?bookId=847. (Accessed: 6th May 2018)