Oral semaglutide and cardiovascular risk profile in type 2 diabetes

Takeaway

• PIONEER 6 trial demonstrated that the cardiovascular risk profile of oral semaglutide was not inferior to that of placebo in patients with type 2 diabetes (T2D).

Why this matters

• Findings are consistent with cardiovascular outcomes trials of glucagon-like peptide-1 (GLP-1) receptor agonists, all of which confirmed the absence of excess cardiovascular risk.

Study design

• PIONEER 6 trial randomly assigned 3183 patients (mean age, ≥66 years) with cardiovascular or chronic kidney disease to receive either oral semaglutide (n=1591) or placebo (n=1592).
• Primary outcome: occurrence of major adverse cardiovascular events (MACEs: death from cardiovascular causes, non-fatal myocardial infarction or non-fatal stroke).
• Funding: Novo Nordisk.

Key results

• Patients in the oral semaglutide vs placebo group had lower:
  • MACEs (3.8% vs 4.8%; HR, 0.79; 95% CI, 0.57-1.11; P<.001 for non-inferiority),
  • death from cardiovascular causes (0.9% vs 1.9%; HR, 0.49; 95% CI, 0.27-0.92),
  • death from any cause (1.4% vs 2.8%; HR, 0.51; 95% CI, 0.31-0.84) and
  • non-fatal stroke (0.8% vs 1.0%; HR, 0.74; 95% CI, 0.35-1.57).
• Oral semaglutide vs placebo group demonstrated higher:
  • non-fatal myocardial infarction (2.3% vs 1.9%; HR, 1.18; 95% CI, 0.73-1.90) and
  • gastrointestinal adverse events (6.8% vs 1.6%).