Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal AssociationFeb 23, 2026

Semaglutide’s impact on COVID-19 and other infections in the FLOW clinical trial

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jun 27, 2026

Abstract

Essence

Semaglutide reduced serious infection, infection hospitalization, COVID-19 events, and death-related infection risk signals in FLOW participants with type 2 diabetes and chronic kidney disease.

Evidence

A pre-specified randomized trial analysis compared weekly semaglutide 1.0 mg with placebo and found a lower infection SAE, infection hospitalization, or death composite (HR 0.79, 95% CI 0.69-0.89).

Caveat

The larger effects in high HbA1c and high UACR groups are subgroup interaction findings within the same trial, not independently confirmed infection trials.

Simplified

BACKGROUND: In the FLOW trial (ClinicalTrials.gov, NCT03819153), once-weekly subcutaneous semaglutide 1.0 mg versus placebo reduced the risk of major kidney, cardiovascular (CV), and mortality outcomes in participants with type 2 diabetes (T2D) and chronic kidney disease (CKD). This pre-specified analysis assesses the impact of semaglutide on risks of serious infections and coronavirus disease-2019 (COVID-19) in the FLOW trial.

METHODS: The main outcome was a three-component composite (time from randomization to first infection serious adverse event [SAE], first hospitalization due to infection, or all-cause death). Other outcomes included all infection SAEs, COVID-19 adverse events (AEs), COVID-19 SAEs, death due to infection, and death concurrent with a COVID-19 SAE.

RESULTS: Semaglutide reduced the risk of the main outcome versus placebo (hazard ratio [HR] [95% confidence interval (CI)] 0.79 [0.69-0.89]; P = 0.0002). This risk reduction was greater in subgroups with baseline HbA1c > 8% (HR 0.63 [0.52-0.76]) versus ≤ 8% (HR 0.93 [0.79-1.11]; Pinteraction = 0.0027), and UACR ≥2000 mg/g (HR [95% CI] 0.53 [0.39-0.72]) versus UACR <100 mg/g (HR 0.90 [0.58-1.39]; Pinteraction = 0.0367). The semaglutide group had a lower rate of infection SAEs (17.9% versus 21.3%; P = 0.0070), COVID-19 SAEs (6.7% versus 8.8%; P = 0.0155), COVID-19 AEs (20.3% versus 22.9%; P = 0.0190), and hospitalization due to infection (17.5% versus 20.4%; P = 0.015).

CONCLUSIONS: Semaglutide reduced risks of infection SAEs, hospitalization due to infection, and all-cause death with greater benefit among those with poorer glycemic control and greater baseline albuminuria. These findings support potential clinical benefits of semaglutide beyond kidney, CV, and metabolic outcomes in high-risk patients with T2D and CKD.