SUSTAIN 7 published: Semaglutide superior to dulaglutide
medwireNews: Semaglutide has delivered better glycemic control and weight reduction than dulaglutide for patients with type 2 diabetes in the SUSTAIN 7 trial.
Dulaglutide was itself superior to exenatide in the AWARD 1 trial and noninferior to liraglutide in AWARD 6. Semaglutide was also superior to exenatide, in SUSTAIN 3, although the researchers cautioned that the more complex delivery device used for exenatide could have contributed to that finding.
However, Abd Tahrani (University of Birmingham, UK) and co-authors of a commentary accompanying the SUSTAIN 7 publication caution that healthcare providers need to consider more than just glucose-lowering efficacy when choosing antidiabetic medications, such as their effect on weight, hypoglycemia and cardiovascular risk, their side effects, ease of use, and the presence of renal or hepatic impairment.
They stress that “treatment decisions should allow for differences in trial designs and the generalisability of the findings in a real-life setting” and say that more real-world data are needed on glucagon-like peptide-1 receptor agonists “to establish their true place in the management of type 2 diabetes.”
As reported in The Lancet Diabetes & Endocrinology, the phase IIIb SUSTAIN 7 trial involved 1199 patients who had poorly controlled type 2 diabetes, despite metformin treatment. They were randomly assigned to receive weekly open-label injections of semaglutide or dulaglutide at their low doses of 0.5 and 0.75 mg, respectively, or high doses of 1.0 and 1.5 mg.
During 40 weeks of treatment, patients’ glycated hemoglobin (HbA1c) levels fell significantly more with semaglutide than dulaglutide, both at the low doses, by 1.5% versus 1.1%, and the high doses, by 1.8% versus 1.4%.
The differences favoring semaglutide were significant for both superiority and noninferiority, report Richard Pratley (Florida Hospital Translational Research Institute for Metabolism and Diabetes, Orlando, USA) and co-researchers.
More patients achieved glycemic control targets with semaglutide versus dulaglutide. In the high-dose groups, for example, 79% versus 67% achieved HbA1c below 7.0%, and 67% versus 47% achieved a target of 6.5% or lower.
Average bodyweight decreased by 4.6 versus 2.3 kg among patients taking the low doses of semaglutide and dulaglutide, respectively, and by 6.5 versus 3.0 kg in the high-dose groups. Significantly more patients taking semaglutide than dulaglutide achieved HbA1c below 7.0% without severe hypoglycemia or any weight gain, at 74% versus 58% among those taking the high doses.
Adverse events occurred at similar rates among the groups, with the exception of gastrointestinal events, which were less frequent among patients taking low-dose dulaglutide, at 33% versus 43–48% in the other groups. Discontinuation because of adverse events was slightly more common with semaglutide than dulaglutide, at 8–10% versus 5–7%.
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