Efficacy and safety of once-weekly semaglutide 2·0 mg versus 1·0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial
RCT (n=961) found semaglutide 2mg provided superior HbA1c and weight reduction vs the 1mg dose (-2.2% vs -1.9%, p=0.0003; & -6.9kg vs -6.0kg, p=0.015). Serious adverse events were similar between treatment groups; 4% and 5% of participants given 2mg and 1mg doses respectively.
Source:
The Lancet
SPS commentary:
A related commentary notes the positive findings, but states however that the add-on value of semaglutide 2·0 mg versus 1·0 mg once-weekly appears rather poor, when considering the incremental reductions in HbA1c and bodyweight. The changes were statistically significant but barely clinically relevant. Other therapeutic options could be considered instead of increasing the dose of the GLP-1 receptor agonist, for instance a combination with a SGLT2 inhibitor, a dual therapy that also improves glucose control, reduces bodyweight, lowers blood pressure, and has the potential to improve both cardiovascular and renal outcomes. To this end, a pharmacoeconomical comparison using hard clinical outcomes between a higher dose of GLP-1 receptor agonist and such a dual therapy would be of major interest.