Semaglutide Shows Greater Weight Reduction Compared to Dulaglutide in SUSTAIN 7

Adie Viljoen, MBChB, Mmed, FCPath, FRCPath, MBA

In a post-hoc exploratory analysis of the SUSTAIN 7 trial, semaglutide (Ozempic, Novo Nordisk) showed greater reductions in weight in comparison with dulaglutide in adults with type 2 diabetes—the greatest reductions occurring in patients with a baseline body mass index (BMI) of ≥25 kg/m².

Presented as a poster at the American Diabetes Association 78^th Annual Scientific Sessions in Orlando, Florida, the trial’s primary endpoint was the change from baseline in A1C and the secondary endpoint was focused on BMI-based change in body weight. The analysis divvied patients into subgroups based on BMI: <25 kg/m²; 25 to <30 kg/m²; 30 to <35 kg/m²; and ≥35 kg/m².

“Globally, up to 90% of people with type 2 diabetes are overweight or have obesity. Therefore, it is important to consider how to manage weight in this population,” said Adie Viljoen, MBChB, Mmed, FCPath, FRCPath, MBA, the SUSTAIN 7 chief investigator and a consultant chemical pathologist at East and North Hertfordshire NHS Trust, in a statement. “Based on the SUSTAIN clinical trial [program], Ozempic can help people living with type 2 diabetes manage their A1C and has the potential to help them lose some weight.”

More than 8000 adults with type 2 diabetes were assessed in the SUSTAIN program, 1200 of which were randomized in SUSTAIN 7 to the glucagon-like peptide-1 (GLP-1) receptor in doses of 0.5 mg or 1 mg and dulaglutide in doses of 0.75 mg and 1.5 mg. The greater reduction in weight from the 95.2 kg baseline mean was shown across the BMI subgroups when comparing semaglutide’s 0.5-mg dose to dulaglutide’s 0.75-mg dose (range across all groups, 3.6 kg to 5.5 kg vs. 0.9 kg to 3.4 kg).

In comparison with 1.5 mg dulaglutide, the 1-mg dose of semaglutide showed similar results, with weight loss ranging from 5.2 kg to 7.6 kg compared to 2.0 kg to 3.8 kg with dulaglutide. Additionally, more patients in the semaglutide arm achieved weight loss of equal to or better than 5% and 10% of body weight compared to the dulaglutide group, in all BMI subgroups.

With regard to gastrointestinal adverse events, patients being administered the 0.75-mg dose of dulaglutide reported the fewest events compared with the other 3 treatment groups. Gastrointestinal adverse events were the most common adverse events, occurring at a rate of ≥5%, associated with both doses of the Novo Nordisk injection.

The post-hoc analysis was conducted using Mixed Models for Repeated Measurements. The interaction effect between the treatments and subgroups was not statistically significant (semaglutide 0.5 mg vs. dulaglutide 0.75 mg: P = .9118; semaglutide 1 mg vs. dulaglutide 1.5 mg: P = .8175).

Just recently, a supplemental analysis of the PIONEER 4 and PIONEER 7 trials revealed that the oral form of semaglutide was capable of greater glycated hemoglobin (HbA1c) and body weight reduction versus liraglutide (Victoza) and sitagliptin (Januvia) adults with type 2 diabetes. With the subcutaneous form of the investigative drug gaining US Food and Drug Administration (FDA) approval for adults with T2D last month, the new results hold promise for Novo Nordisk’s oral therapy.

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