Comparing medication persistence with oral and subcutaneous semaglutide in a real-world setting

Dec 16, 2024Acta diabetologica

How long people keep taking oral versus injected semaglutide in real life

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Abstract

The proportion of patients continuing treatment with oral semaglutide was significantly lower at 18 months compared to subcutaneous semaglutide, at 46.0% vs. 83.8%.

A total of 242 patients were included, with an equal split between oral and subcutaneous semaglutide users.
Patients using oral semaglutide were older and had a lower body mass index at baseline compared to those using the subcutaneous form.
At 6, 12, and 18 months, persistence to treatment was significantly lower in the oral group, with rates dropping to 46.0% at 18 months.
Gastro-intestinal side effects were the most common reasons for discontinuation of oral semaglutide.
When adjusted for age and body mass index, no significant differences were observed in weight loss or HbA1c reduction between the two formulations.

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AIMS: To compare medication persistence and efficacy of oral and subcutaneous semaglutide, in a real-world setting.

MATERIALS AND METHODS: This is a single-center, retrospective observational cohort study. Patients with type 2 diabetes mellitus (T2DM) starting treatment with either formulation of semaglutide between January 1 2019 and July 31 2023 and with at least one follow-up visit were included. The primary endpoint was the difference in the proportion of patients that continued treatment after 6, 12 and 18 months. Main secondary endpoints were change in HbA1c and body weight.

RESULTS: We included 242 patients on oral (n = 121) and subcutaneous (n = 121) semaglutide. At baseline, patients in the oral semaglutide group were significantly older (mean age: 67 ± 11 vs. 63 ± 11 years, p = 0.002) and had a lower body mass index (BMI: 30.5 ± 5.6 vs. 33.9 ± 7.1 kg/m, p < 0.001). The proportion of patients persistent to treatment was significantly lower in the oral group at 6 (85.3% vs. 94.8%; p < 0.001), 12 (72.3% vs. 92.4%, p < 0.001) and 18 (46.0% vs. 83.8%; p < 0.001) months. Most common reasons for discontinuation were gastro-intestinal side effects. When adjusted for age and BMI, body weight and HbA1c reduction were not significantly different between the two formulations, as the proportion of patients achieving the composite outcome of weight loss ≥ 5% and HbA1c < 7.0%. 2

CONCLUSIONS: The present real-world study suggests that persistence is significantly lower when semaglutide is administered as a once-daily tablet compared with a weekly injection, while there are no differences in efficacy between the two formulations.

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Comparing medication persistence with oral and subcutaneous semaglutide in a real-world setting

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