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Semaglutide and cardiovascular outcomes in T2D

Semaglutide, a glucagon-like peptide-1 analogue with an extended half-life of approximately 1 week (currently unavailable in the UK), was assessed to establish cardiovascular safety. The preapproval study SUSTAIN-6 (Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes) was designed to assess the non-inferiority of semaglutide as compared with placebo in terms of cardiovascular safety in people with type 2 diabetes. Semaglutide-treated participants had a significant 26% lower risk of the primary composite outcome of death from cardiovascular causes, non-fatal myocardial infarction or non-fatal stroke than did those receiving placebo.

By Colin Kenny, GP, Dromore

In this trial, 3297 participants with type 2 diabetes who were at high cardiovascuar (CV) risk were randomly assigned to receive once-weekly semaglutide or placebo for 104 weeks. The primary outcome was the first occurrence of CV death, non-fatal myocardial infarction or non-fatal stroke. In all, 2735 (83.0%) participants had established CVD, chronic kidney disease CKD or both at baseline.

The primary outcome occurred in 6.6% of participants in the semaglutide group and 8.9% of those in the placebo group. Non-fatal myocardial infarction occurred in 2.9% of individuals receiving semaglutide and 3.9% of those receiving placebo. Non-fatal stroke occurred in 1.6% and 2.7% of participants in the respective groups. The semaglutide group had lower rates of nephropathy and serious adverse events but higher rates of retinopathy and drug discontinuation due to adverse events.

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