Effect of semaglutide versus placebo on cardiorenal outcomes by prior cardiovascular disease and baseline body mass index: Pooled post hoc analysis of SUSTAIN 6 and PIONEER 6.

AIMS: Cardiorenal effects of semaglutide in people with type 2 diabetes (T2D) at high cardiovascular (CV) risk were investigated. MATERIALS AND METHODS: Post hoc analyses of pooled SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716) data assessed time to primary major adverse CV events (MACE; CV death, non-fatal myocardial infarction, or non-fatal stroke), expanded MACE (MACE + hospitalisation for unstable angina or heart failure), CV death, all-cause death, and new or worsening nephropathy. The impact of body weight (BW) changes on primary MACE risk was also evaluated. Participants were stratified by prior CV disease (CVD) status and baseline body mass index (BMI). RESULTS: Semaglutide significantly reduced the risk of primary and expanded MACE, with a nonsignificant risk reduction of CV and all-cause death versus placebo in the overall population; the effect was consistent across all subgroups (p >0.05 for all comparisons). Semaglutide consistently reduced nephropathy risk versus placebo in the SUSTAIN 6 population (HR [95% CI]: 0.64 [0.46; 0.88], p = 0.0054) and across all subgroups (p >0.05 for all comparisons). When accounting for BW changes, treatment effects on primary MACE risk in the overall population and by BMI subgroups remained similar compared with the results of the main analysis. CONCLUSIONS: Semaglutide treatment improved cardiorenal outcomes versus placebo in people with T2D, regardless of prior CVD and baseline BMI. This improvement was observed even when accounting for changes in BW, indicating direct effects of semaglutide on the cardiorenal system. This analysis supports the broad efficacy of semaglutide in a diverse T2D population.