Ildiko Lingvay, MD: Switching from Other GLP-1s to Once-Weekly Semaglutide


Results of the EXPERT study could help guide clinical decision making for GLP-1 RA-experienced patients.

Results of the EXPERT study presented at the American Diabetes Association’s (ADA) 80th Scientific Sessions is offering clinicians an overview of the real-world outcomes for GLP-1 receptor agonist-experienced patients when switching to once-weekly semaglutide.

While observational in design, results of the study indicated GLP-1 RA-experienced patients switching to semaglutide experienced greater weight loss and significant improvements in HbA1c 1-year after switching.

“It’s looking at a very common situation we have in clinics, where patients get switched from any other GLP-1 receptor agonist to once-weekly semaglutide,” said Ildiko Lingvay, MD, MPH, professor of medicine at University of Texas Southwestern and medical director of the Office of Clinical Trials Management at UT Southwestern Medical Center, in an interview with HCPLive®. “And, if you know about randomized clinical trials, none of the randomized trials allowed GLP-1 medication to be used in the background during these phase 3 trials.”

To identify such a patient population, Lingvay and a team of colleagues designed the EXPERT study to use data from the IBM Watson Health US electronic medical records database. For inclusion in the study, patients needed to have 1 or more prescriptions for semaglutide and a prescription for any other GLP-1 RA in the 365 days before the earliest semaglutide prescription.

Further inclusion criteria required patients to have undergone an HbA1 or weight measurement before the index date and have corresponding follow-up measurements at 6 months and/or 12 months. Of note, participants younger than 18 years old were excluded from the study.

An additional sensitivity analysis was included as part of the EXPERT study’s design to evaluate changes in HbA1c and weight in patients with 2 or more prescriptions for the same GLP-1 RA within the 365 days preceding earliest semaglutide prescription.

In total, 1087 patients with type 2 diabetes were identified for analysis. From this cohort, 365 patients had valid HbA1c measurements and 480 had valid weight measurements available from 6-month follow-ups.

Results of the analysis indicated switching to semaglutide was associated with significant reductions in HbA1c and weight from baseline to 6 months. Overall, patients who switched to once-weekly semaglutide experienced a -0.7% reduction in HbA1c from baseline to 6 months and that reduction was sustained to month 12 (-0.6% reduction). Investigators pointed out the HbA1c-lowering effect appeared to increase as baseline HbA1c level increased (P <.001 for all changes). &#8232;&#8232;

In regard to weight loss, change in weight from baseline to 6 months was a reduction of -2.2 kg. Whereas HbA1c lowering was sustained from 6 to months to 12 months, weight loss increased from 6 to 12 months, with results suggesting patients experienced a reduction of -3.5 kg from baseline to 12 months (P <.001 for all weight changes).

Investigators also highlighted HbA1c and weight changes observed at 6 and 12 months were not impacted by the baseline GLP-1 RA received by patients. &#8232;&#8232;

To learn more about the impact of switching to once-weekly semaglutide in GLP-1 RA-experienced patients in real-world settings, HCPLive reached out Lingvay to take part in a special edition ADA 2020 House Call.

This study, “GLP-1—Experienced Patients Switching to Once-Weekly Semaglutide in a Real-World Setting (EXPERT Study),” was presented at ADA 2020.

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