Impact on HbA1c and body weight of switching from other GLP‐1 receptor agonists to semaglutide: A model‐based approach

Abstract

Aims Semaglutide is a glucagon‐like peptide‐1 (GLP‐1) analogue approved for the treatment of type 2 diabetes. The impact of switching treatment from another GLP‐1 receptor agonist (GLP‐1RA) to semaglutide was investigated by analyses of exposure‐response models. Methods HbA1c and body weight time‐course models were developed using up to 30 weeks of observations from 4 trials in the semaglutide phase 3 programme. Given the recommended dosing for each GLP‐1RA, pharmacokinetic profiles were simulated based on published population pharmacokinetic models and exposure was adjusted by the relative potencies to ensure that model predictions matched the effects observed in clinical trials. After 26 weeks of simulated treatment with liraglutide, dulaglutide or exenatide extended‐release, simulated semaglutide treatment was initiated one day after the last once‐daily liraglutide dose and one week after the last once‐weekly dulaglutide or exenatide extended‐release doses. Results The potency‐adjusted total effective GLP‐1RA concentration increased after switching from another GLP‐1RA to semaglutide and was associated with reductions ranging from ~0.3 to ~0.8 %‐points for HbA1c and from ~2 to ~4% for body weight with semaglutide 1.0 mg. Temporary slight deteriorations in HbA1c were observed after switching to semaglutide 0.25 mg from liraglutide 1.2/1.8 mg or dulaglutide 1.5 mg. Conclusions Exposure‐response modelling suggests that switching to semaglutide from liraglutide, dulaglutide or exenatide extended‐release results in further reductions in HbA1c and body weight. Initial slight deterioration in outcome values when switching to semaglutide 0.25 mg could be avoided by initiating semaglutide treatment at a higher dose.