Semaglutide comes out on top in GLP1RA CVD comparison

  • Alfayez OM & al.
  • Cardiovasc Diabetol
  • 22 jun. 2020

  • de Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Glucagon-like peptide-1 receptor agonists (GLP1RAs) offer significant cardiovascular (CV) safety benefits, according to an analysis of data from CV outcomes trials.
  • An indirect comparison across trials suggests once-weekly semaglutide and oral semaglutide may be preferred GLP1RAs in patients with type 2 diabetes (T2D) with established or at high risk for CV disease (CVD).

Why this matters

  • No head-to-head trials compare CV outcomes among different GLP1RAs.

Study design

  • Indirect comparison of data from 7 GLP1RA CV outcomes trials, including 56,004 patients with T2D and established CVD or risk factors.
  • Funding: King Saud University, Riyadh, Saudi Arabia.

Key results

  • With weekly injected semaglutide vs lixisenatide, significant reductions seen in major adverse cardiovascular events (MACE): OR, 0.71 (95% CI, 0.52-0.96).
  • MACE risk reductions also seen with albiglutide vs lixisenatide: OR, 0.76 (95% CI, 0.61-0.93).
  • Weekly semaglutide had highest probability of ranking first in MACE reduction (52%) followed by oral semaglutide (26%) and albiglutide (20%).
  • CV mortality (ORs; 95% CIs) was significantly reduced with:
    • Semaglutide vs exenatide: 0.47 (0.21-0.99).
    • Semaglutide vs dulaglutide: 0.46 (0.20-0.97).
    • Semaglutide vs albiglutide: 0.45 (0.19-0.97). 
    • Semaglutide vs lixisenatide: 0.43 (0.19-0.92).
  • Semaglutide also had the highest probability of ranking first (>90%) in CV mortality reduction.

Limitations

  • Intertrial differences in study populations, MACE component results.
  • Albiglutide is no longer available.
  • Other decision-making parameters, such as cost, weight reduction, and glycemic control not addressed.