Target Trial of Semaglutide Versus Dulaglutide or Liraglutide in Patients Receiving Hemodialysis.
Semaglutide may be associated with lower mortality and hospitalization rates compared to dulaglutide or liraglutide in patients on hemodialysis, but the clinical significance of these findings requires cautious interpretation.
Where it sits
this study against the rest of the dulaglutide corpusSummary and findings
This study evaluated the comparative effectiveness of semaglutide versus dulaglutide or liraglutide in patients with diabetes undergoing maintenance hemodialysis. The analysis included 1,312 semaglutide users and 2,601 dulaglutide or liraglutide users over a median follow-up of 1.1 years. Findings suggested that semaglutide was associated with lower mortality and hospitalization rates compared to dulaglutide or liraglutide.
Abstract
<h4>Objective</h4>To evaluate the comparative effectiveness of semaglutide versus dulaglutide or liraglutide in patients with diabetes receiving maintenance hemodialysis.<h4>Research design and methods</h4>Using 2011-2022 U.S. Renal Data System and Medicare data, we emulated a target trial evaluating semaglutide versus dulaglutide or liraglutide in patients receiving hemodialysis. Overlap weights were used to adjust for confounders. Fine-Gray models were used to assess death on dialysis and hospitalization. A generalized estimating equation was used for repeated measures of body weight.<h4>Results</h4>We identified 1,312 semaglutide and 2,601 dulaglutide or liraglutide users. After overlap weighting, the effective sample size was 3,200 patients (mean age 61; 63% White; 28% Black; 52% male; median [interquartile range] BMI 34 [29-40] kg/m2; median follow-up 1.1 [0.6-1.9] years). Semaglutide versus dulaglutide or liraglutide was associated with a mortality on dialysis subdistribution hazard ratio (sHR) of 0.82 (95% CI 0.70-0.97; 1-year cumulative incidence 11% vs. 13%) and all-cause hospitalization sHR of 0.91 (95% CI 0.83-0.99; 1-year incidence 57% vs. 62%). Body weight loss was higher with semaglutide (-4.8%, 95% CI -5.3% to -4.2%) at 1 year vs. -3.4%, 95% CI -3.9% to -3.1%). Direct comparisons of semaglutide versus dulaglutide showed similar results for mortality (sHR 0.82, 95% CI 0.69-0.97) and hospitalization (sHR 0.88, 95% CI 0.81-0.97), but semaglutide versus liraglutide showed no statistically significant benefit for mortality or hospitalization.<h4>Conclusions</h4>Among patients with diabetes receiving hemodialysis and equipoise between semaglutide and dulaglutide or liraglutide, semaglutide may be the preferred glucagon-like peptide 1 agent compared with dulaglutide.
Background
Not reported in abstract.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Limitations
Not reported in abstract.