Wang Sihua, Wang Sheng, Wang Yan, Luan Jiajie
Department of Pharmacy, Yijishan Hospital of Wannan Medical College, 2 Zheshan W Rd, Jinghu District, Wuhu, 241001, Anhui, China.
Department of Pharmacy, Wannan Medical College, 22 Wenchang W Rd, Yijiang District, Wuhu, 241002, Anhui, China.
Diabetes Ther. 2024 Feb;15(2):497-519. doi: 10.1007/s13300-023-01520-3. Epub 2024 Jan 4.
Semaglutide is a high-profile glucose-lowering drug that medical decision-makers have acknowledged in recent years. This rapid review aims to provide evidence-based clinical recommendations for the treatment of type 2 diabetes mellitus (T2DM) with semaglutide.
We conducted a rapid review of randomized controlled trial (RCT)-based meta-analyses (MAs) and systematic reviews (SRs) of cost-effectiveness analyses (CEAs) compared to other glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or placebo in patients with T2DM. Prospective cohort real-world studies (RWS) were also retrieved and subjected to MA. Four databases, including PubMed, the Cochrane Library, Embase, and ISPOR, were searched from inception to 5 March 2023. The outcomes of interest were hemoglobin A1c (HbA1c), body weight, major adverse cardiovascular events (MACE), and economic outcomes such as quality-adjusted life-years and total cost.
We identified 33 publications: 22 RCT-based MAs, 1 SR of CEAs, and 10 RWS. Evidence showed that semaglutide at usual doses was associated with superior reductions in HbA1c and weight compared to most GLP-1 RAs in patients with T2DM who were drug naive, receiving basal insulin, or using oral hypoglycemic agents, and it was also associated with a lower number of MACE and was more cost-effective. Further, once-weekly semaglutide resulted in a significant reduction in HbA1c levels (-1.1%) and body weight (-4.88 kg) in routine clinical practice.
This review consolidates the positive current evidence base for prescribing semaglutide to patients with T2DM, but further rigorous studies are still urgently required to develop practice guidelines as innovative drugs become commercially available.
司美格鲁肽是近年来医学决策者认可的一种备受瞩目的降糖药物。本快速综述旨在为司美格鲁肽治疗2型糖尿病（T2DM）提供循证临床建议。
我们对基于随机对照试验（RCT）的荟萃分析（MA）以及与其他胰高血糖素样肽-1受体激动剂（GLP-1 RA）或安慰剂相比在T2DM患者中进行的成本效益分析（CEA）的系统评价（SR）进行了快速综述。还检索了前瞻性队列真实世界研究（RWS）并进行了MA。检索了四个数据库，包括PubMed、Cochrane图书馆、Embase和ISPOR，检索时间从创建至2023年3月5日。感兴趣的结局包括糖化血红蛋白（HbA1c）、体重、主要不良心血管事件（MACE）以及经济结局，如质量调整生命年和总成本。
我们确定了33篇出版物：22篇基于RCT的MA、1篇CEA的SR和10篇RWS。证据表明，在初治、接受基础胰岛素治疗或使用口服降糖药的T2DM患者中，与大多数GLP-1 RA相比，常规剂量的司美格鲁肽与HbA1c和体重的更显著降低相关，并且还与较少数量的MACE相关且更具成本效益。此外，在常规临床实践中，每周一次的司美格鲁肽导致HbA1c水平显著降低（-1.1%）和体重显著降低（-4.88 kg）。
本综述巩固了目前将司美格鲁肽处方给T2DM患者的积极证据基础，但随着创新药物上市，仍迫切需要进一步的严谨研究来制定实践指南。
