Oral semaglutide cuts MACE risk by 14% in adults with type 2 diabetes: SOUL trial

According to new data from the SOUL trial Oral semaglutide reduced MACE by 14% in Type 2 Diabetes patients. Novo Nordisk will present more detailed data in 2025 and it intends to file for an expanded label for Rybelsus for this population.

Oral semaglutide is administered once daily and is approved for use in three doses, 3 mg, 7 mg and 14 mg, under the brand name Rybelsus. It was  approved by US FDA and is marketed under the name Rybelsus, in September 2019 for treatment of adults with T2D.Later In 2023, the FDA approved a label update for oral semaglutide allowing it to be used as first-line treatment of patients with T2D.

Novo Nordisk has announced the headline results from the SOUL cardiovascular outcomes trial. The double-blinded, randomised trial compared oral semaglutide to placebo as an adjunct to standard of care for the prevention of major adverse cardiovascular events (MACE). The trial enrolled 9,650 people with type 2 diabetes and established cardiovascular disease (CVD) and/or chronic kidney disease (CKD). As part of standard of care, 49% of patients received SGLT2i at some point during the trial.

The trial achieved its primary objective by demonstrating a statistically significant and superior reduction in MACE of 14% for people treated with oral semaglutide compared to placebo. The primary endpoint of the study was defined as the composite outcome of the first occurrence of MACE defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke. All three components of the primary endpoint contributed to the superior MACE reduction demonstrated by oral semaglutide.

In the trial, oral semaglutide appeared to have a safe and well-tolerated profile in line with previous oral semaglutide trials.

"We are pleased to see that the results from SOUL demonstrate that oral semaglutide reduces the risk of cardiovascular events and that the benefits of oral semaglutide come on top of standard of care,” said Martin Holst Lange, executive vice president and head of Development at Novo Nordisk. “Approximately one in three adults with type 2 diabetes also have cardiovascular disease; therefore, it is crucial to have therapies that can address both conditions.”

Novo Nordisk expects to file for regulatory approval of a label expansion for Rybelsus® in both the US and EU around the turn of the year. The detailed results from SOUL will be presented at a scientific conference in 2025.

About the SOUL trial

SOUL was a multicentre, international, randomised, double-blind, parallel-group, placebo-controlled, phase 3 cardiovascular outcomes trial with 9,650 people enrolled. It was conducted to assess the effect of oral semaglutide vs placebo on cardiovascular outcomes in people with type 2 diabetes and established CVD and/or CKD. The SOUL trial was initiated in 2019.

The key objective of SOUL was to demonstrate that oral semaglutide lowers the risk of major adverse cardiovascular events (a composite endpoint consisting of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) compared to placebo, both added to standard of care in patients with type 2 diabetes and established CVD and/or CKD.