NEW ORLEANS — Once-weekly semaglutide appears superior to exenatide extended-release in improving HbA1c and reducing body weight in subjects with type 2 diabetes inadequately controlled on one to two oral agents, according to results from the SUSTAIN-3 trial presented at the American Diabetes Association Scientific Sessions.
“Semaglutide was superior [in] improving glycemic control in those with type 2 diabetes compared with exenatide ER and this was evident both in terms of end of treatment differences and A1c of about 6.2% compared with the exenatide group and in terms of percent of patients reaching an A1c of less than 7%,” Andrew J. Ahmann, MD, of Oregon Health and Science University, said during his presentation.
Andrew J. Ahmann
Ahmann and colleagues conducted a 56-week, open-label study of 813 adults with type 2 diabetes aged 18 years or older who previously failed treatment with metformin, thiazolidinediones or sulfonylureas to assess the efficacy of semaglutide (Novo Nordisk) in reducing HbA1c. The patients had a baseline HbA1c of 7% to 10.5% and glomerular filtration rates greater than 60 mL per minute.
Patients were randomized and administered once-weekly semaglutide at 1 mg (n = 406) or once-weekly exenatide (Byetta, AstraZeneca) ER at 2 mg (n = 407).
Semaglutide produced a 1.5% reduction in mean HbA1c at baseline (8.3%), whereas exenatide ER produced a 0.9% reduction in mean HbA1c at baseline (P < .0001).
Forty-percent of patients who received exenatide ER achieved at least a 7% or lower HbA1c compared with 67% of patients who received semaglutide.
Patients who received semaglutide lost 5.6 kg from baseline (95.8 kg) compared with 1.9 kg in patients who received exenatide ER (P < .0001).
Serious adverse events occurred in 9.4% of patients who received semaglutide and 5.9% of those who received exenatide ER. Hypoglycemia was observed in 7.2% of the semaglutide group and 6.9% of the exenatide ER group. The primary adverse events that occurred in patients were gastrointestinal related – 41.8% in the semaglutide group compared with 33.3% in the exenatide ER group.
“Both treatments were well tolerated – the proportion of patients discontinuing therapy early were similar between the two treatments,” Ahmann said. “There were more gastrointestinal side effects with semaglutide than exenatide, [but] there were more injection-site reactions [22% vs. 1.2%] with exenatide.” – by Ryan McDonald
Ahmann AJ, et al. 187-OR. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.
Disclosure: Ahmann reports serving as an advisor for Eli Lilly and Sanofi, as well as a consultant for Dexcom and Novo Nordisk.