In real-world US care, most patients starting subcutaneous semaglutide did not persist long enough or reach target dosing to match the trial regimen.
Evidence
This retrospective linked EHR-claims study followed 6,537 adults with MASH for 72 weeks after semaglutide initiation and found 68.4% , with only 28 of 358 patients in the 2.4 mg subgroup reaching target within 16 weeks and sustaining it for at least 56 weeks.
Caveat
The study describes treatment patterns rather than MASH resolution, fibrosis outcomes, or causal effects of semaglutide.
Simplified
BACKGROUND: Interim results from the ESSENCE clinical trials indicate that 72-week treatment with high-dose subcutaneous (SC) semaglutide may result in (MASH) resolution and improvements in fibrosis. As some patients with MASH have been prescribed SC semaglutide for the treatment of comorbid type 2 diabetes and/or obesity, this study assessed real-world 72-week treatment patterns among patients with MASH.
METHODS: In a linked electronic health records (Veradigm Network EHR) and claims (Komodo Health) dataset, adults (≥18 years old) with a MASH diagnosis, who initiated treatment with SC semaglutide between 7/1/2018 and 6/30/2023, were identified. Other causes of liver disease (eg, viral hepatitis) or severe complications (eg, cirrhosis) were excluded. The study period included ≥52 weeks before and ≥72 weeks after the first SC semaglutide claim. A subgroup analysis was conducted among those who received the brand approved for 2.4 mg/week dosage (SC semaglutide 2.4) and among people at risk for MASH. Patient characteristics and treatment patterns are reported.
RESULTS: This study identified 6,537 patients with MASH, who initiated treatment with SC semaglutide, 358 of whom received only the brand approved for 2.4 mg/week dosage. Patients were ~50 years old, and a majority were female. occurred in 68.4% of the overall SC semaglutide cohort and 78.5% of the SC semaglutide 2.4 subgroup. The mean time to non-persistence was 24.8 (19.3) and 20.1 (16.9) weeks in the SC semaglutide and SC semaglutide 2.4 groups, respectively. In the SC semaglutide 2.4 subgroup, 182 patients (50.8%) reached the recommended dosage of 2.4 mg/week, and 28 (7.8%) reached the recommended dosage within the first 16 weeks and sustained that dosage for ≥56 weeks. Trends were similar among patients at risk for MASH.
CONCLUSION: In a real-world setting, very few patients achieved the treatment regimen associated with MASH resolution and improvements in fibrosis.
Key numbers
68.4%
Rate
Overall cohort
182 of 358
Achieved Recommended Dosage
2.4 mg subgroup
28 of 358
Sustained Dosage for ≥56 Weeks
2.4 mg subgroup
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