Assessing glycemic and weight-lowering potential of oral semaglutide in type 2 diabetes compared to other GLP-1 receptor agonists in Indian context

Excerpt

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown a significant reduction in glycated hemoglobin (HbA1c) and body weight in people with type 2 diabetes (T2D). In addition, some of the injectable GLP-1RAs such as liraglutide, semaglutide, and dulaglutide have shown a significant reduction in major adverse cardiovascular events (MACE). Among the injected GLP-1RAs, semaglutide deserves special mention at least for two reasons. A higher strength of injectable semaglutide (2.4 mg) is also approved for obesity. Secondly, injectable semaglutide (1.0 mg) has shown superior HbA1C and weight lowering in T2D over several active comparators in the Phase 3 Clinical Development Programme named SUSTAIN (Semaglutide Unabated Sustainability In Treatment of Type 2 Diabetes). This includes the superiority of injectable semaglutide 1.0 mg in both HbA1c and weight lowering over sitagliptin 100 mg (SUSTAIN 2, Global), canagliflozin 300 mg (SUSTAIN 8, Global), liraglutide 1.2 mg (SUSTAIN 10, European), dulaglutide 1.5 mg (SUSTAIN 7, Global), exenatide extended-release 2.0 (SUSTAIN 3, Global), and basal insulin glargine (SUSTAIN 4, Global) [1‐6]. However, injectable semaglutide is not yet available in India. Currently, only two injectable GLP-1RAs such as liraglutide and dulaglutide are available in India. Among these two GLP-1RAs, liraglutide has shown a small but significantly higher weight loss compared to dulaglutide despite similar HbA1c control in AWARD 6 (Assessment of Weekly AdministRation of LY2189265 [dulaglutide] in Diabetes-6) [7]. …