From the SELECT study to SOUL: different administration methods of semaglutide but same efficacy?

Semaglutide, a glucagon-like peptide-1 receptor agonist, is a well-established agent in managing patients with high cardiovascular risk. Initially, a formulation was introduced for weekly subcutaneous administration that demonstrated good tolerability and excellent efficacy in controlling glycaemia in patients with type 2 diabetes mellitus and in reducing body weight in obese and/or overweight subjects, even non-diabetics. Subsequent evidence has shown that the advantages of this drug go beyond simple glucose homoeostasis and weight reduction. Several randomized clinical trials have, in fact, highlighted the effect of semaglutide on improving cardiovascular outcomes with a significant reduction in events in subjects with already diagnosed cardiovascular disease or at high risk. Furthermore, this drug has also proved effective in slowing the progression of nephropathy in diabetic patients and patients with chronic renal failure. These effects are probably due to multiple mechanisms related to weight loss and glycaemic control, anti-inflammatory and antithrombotic properties, and a direct mechanism of vascular and renal protection. More recently, a formulation that requires the oral intake of the drug once a day has been introduced on the market, which maintains the efficacy results of the subcutaneous formulation unchanged.