Real-World Effectiveness of Once-Weekly Semaglutide From a US Commercially Insured and Medicare Advantage Population

Abstract

Purpose: Patients managing type 2 diabetes mellitus (T2DM) often require combination therapy to meet their blood glucose control targets. With limited realworld evidence focused on the use of glucagon-like peptide 1 receptor agonist (GLP-1RA) therapies, the objective of this study was to describe the association between semaglutide once weekly (OW) initiation and changes in hemoglobin A 1c (A 1c ) levels.Methods: This retrospective, descriptive cohort study used the HealthCore Integrated Research Environment (HIRE) to examine commercially insured and Medicare Advantage patients who had T2DM while taking semaglutide OW from December 1, 2017, to April 30, 2019. The first semaglutide OW prescription fill was defined as the study index date. Changes in mean A 1c levels and A 1c target attainment were evaluated among an intention-to-treat (ITT) population (overall group). Furthermore, a persistent population (PP) analysis on the same outcomes was performed that was limited to ITT patients who were observed to continue to use semaglutide OW at the time of the postindex A 1c measurement. In addition, these outcomes were explored in patients stratified based on prior use of GLP-1RA therapy (experienced vs naive) and baseline A 1c values > 9% (75 mmol/mol).Findings: A total of 1888 patients were identified in the overall ITT group. The mean change in the overall ITT group between preindex and postindex A 1c values was −0.9% percentage points ( −9.8 mmol/mol) (mean preindex A 1c , 8.2% [66.1 mmol/mol]) and −1.1 percentage points ( −12.0 mmol/mol) (mean preindex A 1c , 8.2% [66.1 mmol/mol]) in the PP subgroup (all P < 0.001). Among the subgroup of patients with a baseline A 1c value > 9% (75 mmol/mol), percentage

Real-world evaluation of weekly subcutaneous treatment with semaglutide in a cohort of Italian diabetic patients

“…It should also be acknowledged that the 1.0 mg dose was prescribed to only 22% of cases, implying that up-titration was incomplete in most cases possibly due to the choice of clinicians, concomitant therapies of the population sample, and underlying intentions to limit occurrence of side effects. Nevertheless, the effect of treatment on HbA1c and weight was similar to that reported in most RWE studies [ 24 – 31 ]. Points of potential strength of the study are constituted by the wide characterization of our cohort including 102 different variables and the broad representativeness of our patient population.…”

“…RWE studies on GLP-1RAs have provided extensive evidence that OW semaglutide reduces HbA1c and body weight irrespective of previous GLP-1 RA use, with potentially higher persistence than other GLP-1 RAs [ 24 – 43 ]. Our results show that OW semaglutide induced significant reduction in mean HbA1c independent of age, gender, insulin therapy, prior history of GLP-1RA use and diabetic complications.…”

“…Our results seem comparable to those of other RWE studies. While the SUSTAIN studies reported a mean HbA1c reduction from baseline of 1.0–1.5% and HbA1c < 7% in 68.7–82.8% of cases after 6–12 months of treatment [ 53 ], recent retrospective observational studies documented a mean HbA1c reduction of 0.8–1.2% from baseline, with rates of patients achieving HbA1c < 7% ranging between 48.6–53% [ 24 , 26 ]. Further, the number of patients with HbA1c persisting at ≥ 9% values by the end of treatment was 5.3%, a marginal figure that is comparable to rates recorded in registry-based studies [ 24 , 26 ].…”

Effectiveness in Real World of Once Weekly Semaglutide in People with Type 2 Diabetes: Glucagon-Like Peptide Receptor Agonist Naïve or Switchers from Other Glucagon-Like Peptide Receptor Agonists: Results from a Retrospective Observational Study in Umbria

“…In the US, the EXPERT study based on the use of EMRs showed that switching to injectable semaglutide from any other GLP-1RA was associated with significant improvements in HbA1c ( N = 710) at 6 months (− 0.7%) and sustained at 12 months; weight reductions ( N = 921) were also significant at 6 months (− 2.1 kg) and greater at 12 months (− 2.8 kg) [ 26 ]. In addition, data from the US Commercially Insured and Medicare Advantage Population ( N = 1888) showed that naïve patients obtained a reduction in HbA1c two times larger than that of switchers (− 1.2% vs. 0.6%); additionally, among the subgroup of patients with a baseline HbA1c value > 9% (75 mmol/mol), percentage point changes in HbA1c were − 2.2% (− 24.0 mmol/mol) [ 27 ]. Another US retrospective study using Optum's de-identified Clinformatics® Data Mart Database assessed that persistence at 360 days was significantly greater with semaglutide (67%) than for comparators (dulaglutide 56%, liraglutide 40%, and exenatide QW 35.5%), while adherence was comparable or greater [ 28 ].…”

Injectable semaglutide and reductions in HbA1c and weight in the real world in people switched from alternative glucagon‐like peptide‐1 receptor agonists

“…Our findings are broadly comparable with those from existing real-world evidence and RCTs. [1][2][3]5,[7][8][9][10] However, the mean weight and HbA1c in our study were greater than those of RCT cohorts, reflecting current UK practice in management of type 2 diabetes that prioritizes GLP-1RA use for people who are probable to benefit from significant weight loss. We were not able to assess the relative effectiveness of semaglutide doses above 1.0 mg once weekly, nor of oral semaglutide, nor doses of dulaglutide above 1.5 mg once weekly, because these were not licensed at the time of data collection.…”