Editorial board commentary
One of the desirable attributes of any drug, part from its efficacy, is its versatility. This is especially true in the field of diabetology, where multiple drugs are used, often in combination, to achieve safe glycemic control. An ideal glucose-lowering drug should be capable of being prescribed in combination with other classes, and neutralize their adverse effects, if any.
SUSTAIN 2 highlights the greater efficacy of the weekly injectable GLP-1RA semaglutide, as compared to the DPP-4 inhibitor sitagliptin. This result is similar to that noted with the daily GLP-1RA liraglutide, which has earlier been shown to be more effective than sitaglitpin.
Another important fact obtained from SUSTAIN 2 is the ability of semaglutide to be used in combination with metformin and pioglitazone. Semaglutide is also able to cause weight loss, in spite of concomitant glitazone therapy. This must be highlighted, as the potential for weight gain limits the usage of pioglitazone, even though it has been shown to have cerebrovascular benefits.
The discontinuation rate, though higher than for sitagliptin, is lower than observed in other trials on injectable drugs. Appropriate medication counselling will be required,to ensure tolerability, and enhance adherence to semaglutide.
The SUSTAIN trials reported so far (SUSTAIN2, 4, and 6), demonstrate the efficacy of this novel drug as compared to sitaglitpin and glargine, and provide proof of its cardiovascular safety and benefit. These data are encouraging for the diabetes care community, which looks forward to utilizing semaglutide's convenience and effectiveness in clinical care.