Switching from liraglutide to semaglutide leads to weight loss and improves blood sugar control in type 2 diabetes

GLP-1RAs (Glucagon-like peptide-1 receptor agonists) promote insulin secretion in a blood glucose-dependent manner to reduce hypoglycemia occurrence. Simultaneously, glucagon secretion is suppressed. GLP-1RAs also suppress appetite, delay gastric emptying, and have a probable weight-loss effect.

A once-daily human GLP-1RA, liraglutide, has been shown to reduce the incidence of the 3-point MACE (major adverse cardiac events; non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death) compared with a placebo. In patients treated with semaglutide, similar findings were seen. Also, dulaglutide does not result in remarkable between-group differences in the rate of non-fatal myocardial infarction or CV death but significantly reduces the rate of non-fatal stroke. Based on these findings, the Japanese guidelines and the American Diabetes Association recommend using GLP-1RAs as effective therapeutic agents to help patients maintain an everyday life and promote longevity in healthy people.

Against the above background, Yasuo Terauchi, Yokohama City University Graduate School of Medicine, Yokohama, Japan, and colleagues aimed to investigate the effects of switching from liraglutide to semaglutide or dulaglutide on body weight, blood glucose, and the occurrence of adverse effects in clinical practice in an open-label, prospective, randomized, parallel-group controlled trial.

For this purpose, the researchers recruited type 2 diabetes treated with liraglutide (0.9 or 0.6 mg) at Yokosuka Kyosai Hospital in Japan from 2020 to 2022 and, after informed consent was assigned to the dulaglutide or semaglutide group in the ratio of 1:1. Post-treatment changes in the glycated haemoglobin level were evaluated from baseline to weeks 8, 16, and 26.

The study led to the following findings:

• Out of 32 participants initially enrolled, 30 completed the study.
• In the semaglutide group, glycemic control was significantly better than in the dulaglutide group (−0.42 ± 0.49% vs −0.00 ± 0.34%).
• There was a significant body weight reduction in the semaglutide group (−2.6 ± 3.6 kg), whereas the researchers did not observe any change in the dulaglutide group (−0.1 ± 2.7 kilograms).
• A significant difference in body weight was found between the groups.
• The proportion of participants who reported adverse events was 18.8% and 75.0% in the dulaglutide and semaglutide groups, respectively.
• In the semaglutide group, one patient had difficulty continuing treatment due to severe vomiting and weight loss.

"In the semaglutide group, we found a significant improvement in body weight and glycemic control compared with the dulaglutide group," the researchers concluded.

In the semaglutide group, once-daily liraglutide was switched to once-weekly semaglutide 0.5 mg, and in the dulaglutide group, once-daily liraglutide was switched to once-weekly dulaglutide 0.75 mg.

Reference:

Iijima, Takahiro, et al. "Effects of Switching From Liraglutide to Semaglutide or Dulaglutide in Patients With Type 2 Diabetes: a Randomized Controlled Trial." Journal of Diabetes Investigation, 2023.