Disgruntled Dan's Pharmacy Podcast

Episode #3: The new GLP-1 kid on the block - Semaglutide!

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Disgruntled Dan’s Conclusions:

  1. Semaglutide reduces the risk of nonfatal stroke (NNT 97 for 2.1 years), new or worsening nephropathy (NNT 43 over 2.1 years), and revascularization. Yes – there was a reduction in the composite MACE outcomes, but this was primarily driven by the results from nonfatal strokes.
  • Use with caution in patients that currently have retinopathies – Semaglutide may worsen and/or cause retinopathies and the exact cause is currently unknown.
  • Once weekly dosing – convenient for the patient.
  • Start low and go slow, it is a once weekly injection. Due to the long half life it is recommended you start at 0.25mg x 4 weeks THEN 0.5mg x 4 weeks THEN increase to max dose of 1mg.
  • Cost ~$700 for a 4-6 week supply without insurance.
  • It is a new drug. We do not have much experience with it. So I am always cautiously optimistic but I will generally choose options that we have a bit more real world data with before jumping to this. In reality it comes down to that patient sitting in front of you. Remember to keep it patient centred!

    • References

    1. Marso, S. P. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N. Engl. J. Med. 375, 1834–1844 (2016).
  • Fda, Cder & buckmans. Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry. (2016).
  • Sorli, C. et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. lancet. Diabetes Endocrinol. 5, 251–260 (2017).
  • Dungan, K. & DeSantis, A. Glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes mellitus - UpToDate. Available at: https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?search=glp 1&source=search_result&selectedTitle=1~106&usage_type=default&display_rank=1. (Accessed: 6th May 2018)
  • Guyatt, G., Rennie, D., Meade, M. & Cook, D. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed | JAMAevidence | McGraw-Hill Medical. Available at: https://jamaevidence.mhmedical.com/Book.aspx?bookId=847. (Accessed: 6th May 2018)
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    Disgruntled Dan's Pharmacy PodcastBy Disgruntled Dan