SIMILAR EFFICACY AND GASTROINTESTINAL TOLERABILITY VERSUS EXPOSURE FOR ORAL AND SUBCUTANEOUS SEMAGLUTIDE
- Rune V. Overgaard, Denmark
- Rune V. Overgaard, Denmark
- Andrea Navarria, Denmark
- Christin L. Hertz, Denmark
- Steen H. Ingwersen, Denmark
Abstract
Background and Aims
Semaglutide is a glucagon-like peptide-1 analogue formulated as a once-weekly subcutaneous (s.c.) injection and once-daily oral tablet for type 2 diabetes. Lower bioavailability following oral administration results in more variable semaglutide plasma concentrations versus s.c. administration. Effects of administration route on semaglutide efficacy and gastrointestinal tolerability were investigated.
Methods
Population pharmacokinetic data were compared from four 30-week trials (SUSTAIN 1–3, SUSTAIN-Japan) of once-weekly s.c. semaglutide (0.5, 1.0 mg; N=1552) and six 26-week trials (PIONEER 1–3, 5, 8, 9) of once-daily oral semaglutide (3, 7, 14 mg; N=3003). Differences in baseline HbA1c, trial population, diabetes duration, race, ethnicity and sex between populations were balanced by propensity score matching. Exposure–response relationships were investigated for changes from baseline in HbA1c and body weight, and proportion of subjects reporting nausea or vomiting during treatment.
Results
SUSTAIN and PIONEER populations were fairly similar. The exposure range was wider following oral versus s.c. dosing, but with considerable overlap between oral semaglutide (7 and 14 mg) and s.c. semaglutide (0.5 and 1.0 mg), indicating similar exposure levels. HbA1c and weight reductions, and proportions of subjects reporting nausea or vomiting, were greater with increasing semaglutide exposure (Figure). The main covariate for glycaemic effect was baseline HbA1c. Exposure–response relationships were consistent across the SUSTAIN and PIONEER datasets, and even more consistent when using propensity-matched data.
Conclusions
Exposure–response relationships for oral and s.c. semaglutide efficacy and tolerability were similar; the greater variability in semaglutide plasma concentrations following oral administration does not impact response.
