Novo Nordisk A/S, Søborg, Denmark.
Rotherham Institute for Obesity, Rotherham, UK.
Adv Ther. 2020 Mar;37(3):1248-1259. doi: 10.1007/s12325-020-01242-z. Epub 2020 Feb 11.
Once-weekly semaglutide 1 mg is a novel glucagon-like peptide 1 receptor agonist (GLP-1 RA) that, in the SUSTAIN clinical trials, has demonstrated greater reductions in glycated haemoglobin (HbA1c) and body weight than the other GLP-1 RAs exenatide extended-release (ER) 2 mg, dulaglutide 1.5 mg and liraglutide 1.2 mg. The aim of this analysis was to evaluate the relative cost of control of achieving treatment goals in people with type 2 diabetes (T2D) treated with once-weekly semaglutide versus exenatide ER, dulaglutide and liraglutide from a UK perspective.
Proportions of patients reaching HbA1c targets (< 7.0% and < 7.5%), weight loss targets (≥ 5% reduction in body weight) and composite endpoints (HbA1c < 7.0% without weight gain or hypoglycaemia; reduction in HbA1c of ≥ 1% and weight loss of ≥ 5%) were obtained from the SUSTAIN clinical trials. Annual per patient treatment costs were based on wholesale acquisition costs from July 2019 in the UK. Cost of control was calculated by plotting relative treatment costs against relative efficacy.
The annual per patient cost was similar for all GLP-1 RAs. Once-weekly semaglutide was superior to exenatide ER, dulaglutide and liraglutide in bringing patients to HbA1c and weight loss targets, and to composite endpoints. When looking at the composite endpoint of HbA1c < 7.0% without weight gain or hypoglycaemia, exenatide ER, dulaglutide and liraglutide were 50.0%, 21.6% and 51.3% less efficacious in achieving this, respectively, than once-weekly semaglutide. Consequently, the efficacy-to-cost ratios for once-weekly semaglutide were superior to all comparators in bringing patients to all endpoints.
The present study showed that once-weekly semaglutide offers superior cost of control versus exenatide ER, dulaglutide and liraglutide in terms of achieving clinically relevant, single and composite endpoints. Once-weekly semaglutide 1 mg would therefore represent good value for money in the UK setting.
每周一次皮下注射司美格鲁肽 1mg 是一种新型胰高血糖素样肽 1 受体激动剂（GLP-1RA），在 SUSTAIN 临床试验中，与其他 GLP-1RA（艾塞那肽延长释放剂 2mg、度拉糖肽 1.5mg 和利拉鲁肽 1.2mg）相比，司美格鲁肽 1mg 能更显著地降低糖化血红蛋白（HbA1c）和体重。本分析旨在从英国的角度评估每周一次皮下注射司美格鲁肽与艾塞那肽延长释放剂、度拉糖肽和利拉鲁肽相比，在实现 2 型糖尿病（T2D）患者治疗目标的控制成本方面的相对成本。
从 SUSTAIN 临床试验中获得达到 HbA1c 目标（<7.0%和<7.5%）、体重减轻目标（体重减轻≥5%）和复合终点（HbA1c<7.0%且无体重增加或低血糖；HbA1c 降低≥1%且体重减轻≥5%）的患者比例。根据英国 2019 年 7 月的批发采购成本，计算每位患者每年的治疗成本。通过绘制相对治疗成本与相对疗效的关系图来计算控制成本。
所有 GLP-1RA 的每位患者的年治疗成本均相似。与艾塞那肽延长释放剂、度拉糖肽和利拉鲁肽相比，每周一次皮下注射司美格鲁肽能更有效地使患者达到 HbA1c 和体重减轻目标，并达到复合终点。在观察 HbA1c<7.0%且无体重增加或低血糖的复合终点时，艾塞那肽延长释放剂、度拉糖肽和利拉鲁肽在实现这一目标方面的疗效分别比每周一次皮下注射司美格鲁肽低 50.0%、21.6%和 51.3%。因此，每周一次皮下注射司美格鲁肽在使患者达到所有终点方面的疗效-成本比均优于所有对照药物。
本研究表明，每周一次皮下注射司美格鲁肽在实现临床相关的单一和复合终点方面，与艾塞那肽延长释放剂、度拉糖肽和利拉鲁肽相比，具有更好的成本控制效果。因此，每周一次皮下注射司美格鲁肽 1mg 在英国具有良好的成本效益。
