Oral semaglutide bests empagliflozin in reducing weight and HbA1c in diabetes
Delhi: Oral semaglutide, glucagon-like peptide 1 (GLP-1) analog, outperformed sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin in reducing HbA1c levels and weight in patients with type 2 diabetes uncontrolled on metformin -- findings from The PIONEER 2 Trial.
Results of the study, published in the Diabetes Care journal found that at 26 weeks, oral semaglutide was superior to empagliflozin in reducing HbA1c but not body weight. At week 52, HbA1c and body weight were significantly reduced versus empagliflozin.
, Endocrine and Metabolic Consultants, Rockville, MD, and colleagues compared the efficacy and safety of oral semaglutide and empagliflozin in patients with type 2 diabetes uncontrolled on metformin that had HbA1c levels of 53 mmol/mol (7.0%) and above.
Participants were randomised to receive once-daily doses of either oral semaglutide (14mg dose) (n=142) or empagliflozin (25mg dose) (n=410) in a 52-week trial. Both groups took these medications in addition to metformin. Four-hundred (97.1%) patients in the oral semaglutide group and 387 (94.4%) in the empagliflozin group completed the trial
Key endpoints were change from baseline to week 26 in HbA1c (primary) and body weight (confirmatory secondary).
Key findings include:
- Oral semaglutide provided superior reductions in HbA1c versus empagliflozin at week 26 (treatment policy –1.3 vs. –0.9% [–14 vs. –9 mmol/mol], estimated treatment difference [ETD] –0.4% [–5 mmol/mol (–6, –3 mmol/mol)]).
- The treatment difference in HbA1c significantly favored oral semaglutide at week 26 for the trial product estimand (–1.4 vs. –0.9% [–15 vs. –9 mmol/mol], ETD –0.5% [–6 mmol/mol (–7, –5 mmol/mol)]) and at week 52 for both estimands.
- Superior weight loss was not confirmed at week 26 (treatment policy), but oral semaglutide was significantly better than empagliflozin at week 52 (trial product −4.7 vs. −3.8 kg).
- Gastrointestinal adverse events were more common with oral semaglutide.
"Oral semaglutide was superior to empagliflozin in reducing HbA1c but not body weight at 26 weeks in patients with type 2 diabetes uncontrolled on metformin. At week 52, HbA1c and body weight (trial product estimand) were significantly reduced versus empagliflozin. Oral semaglutide was well tolerated within the established safety profile of GLP-1 receptor agonists," wrote the authors.
More Information: "Oral Semaglutide Versus Empagliflozin in Patients With Type 2 Diabetes Uncontrolled on Metformin: The PIONEER 2 Trial" published in the Diabetes Care journal.
DOI: https://doi.org/10.2337/dc19-0883
Journal Information: Diabetes Care
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