Blockbuster Diabetes and Weight-Loss Drug Semaglutide Can Reduce Kidney Failure, Heart Attack Risk: NEJM Study

Semaglutide, the mega-seller diabetes and weight-loss drug, can significantly reduce the risk of side effects such as kidney failure, heart attacks, and death in patients with type 2 diabetes and kidney disease, according to a study published in the New England Journal of Medicine (NEJM).

This development is encouraging because semaglutide – a glucagon-like peptide-1 (GLP-1) receptor agonist – could provide treatment options to improve patient outcomes and quality of life. Patients with type 2 diabetes and chronic kidney disease face a high risk of kidney failure, heart problems, and death.

The findings suggest that a weekly injection of semaglutide may help prevent complications such as chronic kidney disease and end-stage renal disease, which frequently accompany obesity and diabetes.

The study published on May 24, titled “Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes” found that patients who received semaglutide “once a week” had a 24 per cent lower risk of their kidney disease worsening or of dying prematurely from cardiovascular or kidney-related causes compared to those who received a placebo or a dummy drug.

The study involved over 3,500 patients with follow-ups extending over three years and showed that the once-weekly drug treatment reduced the risk of major cardiovascular events, such as heart attacks, by 18 per cent and the risk of death from any cause by 20 per cent.

How the study was conducted

Semaglutide works by lowering high blood sugar by increasing insulin release, reducing glucagon levels, and delaying gastric emptying. Additionally, it also helps control appetite, reducing patient’s desire to eat.

The researchers randomly assigned patients with type 2 diabetes and chronic kidney disease to receive semaglutide injection at a dose of 1.0 mg weekly or placebo which means no drug.

The parameters for the study included major kidney disease events which included a variety of kidney failures including dialysis, transplantation, or impacted eGFR (estimated glomerular filtration rate) which is a measure of how well your kidneys are working.

The 3,533 participants who underwent randomisation – out of which 1767 were in the semaglutide group and 1766 were in the placebo group – were followed up for 3.4 years (median follow-up) after the trial cessation.

“The risk of a primary-outcome event was 24 per cent lower in the semaglutide group than in the placebo group,” the study said. “Results were similar for a composite of the kidney-specific components of the primary outcome and for death from cardiovascular causes.”

According to the study, “the results for all confirmatory secondary outcomes favoured semaglutide.”

“The mean annual eGFR slope was less steep (indicating a slower decrease), the risk of major cardiovascular events 18 per cent lower and the risk of death from any cause 20% lower.”

“Serious adverse events were reported in a lower percentage of participants in the semaglutide group than in the placebo group,” the study said while adding that the participants in the semaglutide group reported 49.6 per cent side effects whereas those in the dummy pill group reported 53.8 per cent side effects.

Impressive findings: Experts

According to experts the findings of the study are “quite significant”.

According to Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare, Saket, New Delhi, “Semaglutide has been shown to have cardio-protective properties. It reduces the risk of major adverse cardiovascular events by about 20 per cent.”

He explained that semaglutide was originally developed for treating diabetes. “This class of drugs GLP1RAs reduces blood glucose but does not produce low blood glucose reactions, that is hypoglycemia,” he said.

In addition, these drugs induce weight loss to a much greater degree than what was seen previously. Semaglutide can induce a loss of 15 per cent of baseline body weight, which is far greater than what its predecessors could do.

The FLOW study, published last week, is important as it is the first study on semaglutide which has looked primarily at renal outcomes (like worsening kidney disease or death due to kidney or cardiovascular causes), Mithal explained and added that “quite remarkably, there’s a 24 per cent reduction in the risk of developing advanced kidney disease.”

“I think that is quite a remarkable statistic. Very few drugs have been shown to reduce the progression of kidney disease in people with diabetes,” Mithal stated.

“Semaglutide is a leading medication that significantly reduces weight and blood sugar levels. We now have strong evidence that it also provides protection for the heart and kidneys. We are pleased to offer such an effective drug to safeguard our patients’ health and extend their lives,”said Anoop Misra, Chairman, Fortis-C-DOC Centre of Excellence for Diabetes.

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