Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio (W.W., N.A.B.).
National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland (N.D.V.).
Ann Intern Med. 2024 Aug;177(8):1016-1027. doi: 10.7326/M23-2718. Epub 2024 Jul 30.
Reports of reduced desire to smoke in patients treated with semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA) medication for type 2 diabetes mellitus (T2DM) and obesity, have raised interest about its potential benefit for tobacco use disorders (TUDs).
To examine the association of semaglutide with TUD-related health care measures in patients with comorbid T2DM and TUD.
Emulation target trial based on a nationwide population-based database of patient electronic health records.
United States, 1 December 2017 to 31 March 2023.
Seven target trials were emulated among eligible patients with comorbid T2DM and TUD by comparing the new use of semaglutide versus 7 other antidiabetes medications (insulins, metformin, dipeptidyl-peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, and other GLP-1RAs).
The TUD-related health care measures (medical encounter for diagnosis of TUD, smoking cessation medication prescriptions, and smoking cessation counseling) that occurred within a 12-month follow-up were examined using Cox proportional hazards and Kaplan-Meier survival analyses.
The study compared 222 942 new users of antidiabetes medications including 5967 of semaglutide. Semaglutide was associated with a significantly lower risk for medical encounters for TUD diagnosis compared with other antidiabetes medications, and was strongest compared with insulins (hazard ratio [HR], 0.68 [95% CI, 0.63 to 0.74]) and weakest but statistically significant compared with other GLP-1RAs (HR, 0.88 [CI, 0.81 to 0.96]). Semaglutide was associated with reduced smoking cessation medication prescriptions and counseling. Similar findings were observed in patients with and without a diagnosis of obesity. For most of the group comparisons, the differences occurred within 30 days of prescription initiation.
Documentation bias, residual confounding, missing data on current smoking behavior, body mass index, and medication adherence.
Semaglutide was associated with lower risks for TUD-related health care measures in patients with comorbid T2DM and TUD compared with other antidiabetes medications including other GLP-1Ras, primarily within 30 days of prescription. These findings suggest the need for clinical trials to evaluate semaglutide's potential for TUD treatment.
National Institutes of Health.
接受胰高血糖素样肽受体激动剂（GLP-1RA）类药物司美格鲁肽治疗的 2 型糖尿病（T2DM）和肥胖症患者报告吸烟欲望降低，这引发了人们对其治疗烟草使用障碍（TUD）潜在益处的兴趣。
研究司美格鲁肽与合并 T2DM 和 TUD 患者的 TUD 相关医疗措施之间的关联。
基于全国患者电子健康记录的基于人群的数据库的模拟目标试验。
美国，2017 年 12 月 1 日至 2023 年 3 月 31 日。
通过比较新使用司美格鲁肽与其他 7 种抗糖尿病药物（胰岛素、二甲双胍、二肽基肽酶-4 抑制剂、钠-葡萄糖共转运蛋白-2 抑制剂、磺酰脲类药物、噻唑烷二酮类药物和其他 GLP-1RAs），在符合条件的合并 T2DM 和 TUD 的患者中模拟了 7 项目标试验。
使用 Cox 比例风险和 Kaplan-Meier 生存分析检查了 12 个月随访内发生的 TUD 相关医疗措施（TUD 诊断的医疗就诊、戒烟药物处方和戒烟咨询）。
该研究比较了包括 5967 例司美格鲁肽在内的 222942 名新使用抗糖尿病药物的患者。与其他抗糖尿病药物相比，司美格鲁肽与 TUD 诊断相关医疗就诊的风险显著降低，与胰岛素相比降低最明显（风险比 [HR]，0.68 [95%CI，0.63 至 0.74]），与其他 GLP-1RAs 相比虽弱但具有统计学意义（HR，0.88 [CI，0.81 至 0.96]）。司美格鲁肽与减少戒烟药物处方和咨询有关。在有和没有肥胖症诊断的患者中均观察到类似的发现。对于大多数组间比较，差异发生在处方开始后的 30 天内。
文件偏倚、残余混杂、当前吸烟行为、体重指数和药物依从性的数据缺失。
与其他抗糖尿病药物（包括其他 GLP-1RAs）相比，合并 T2DM 和 TUD 的患者使用司美格鲁肽与 TUD 相关医疗措施的风险较低，主要发生在处方开始后的 30 天内。这些发现表明需要进行临床试验来评估司美格鲁肽治疗 TUD 的潜力。
美国国立卫生研究院。
