Real-World Effectiveness of Tirzepatide versus Semaglutide on HbA1c and Weight in Patients with Type 2 Diabetes.

INTRODUCTION: To evaluate real-world hemoglobin A1c (HbA1c) and weight change in adults initiating treatment with tirzepatide (dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist [GLP-1 RA]) or injectable semaglutide (GLP-1 RA) indicated for type 2 diabetes (T2D) management. METHODS: This retrospective analysis utilized the Healthcare Integrated Research Database® to identify adults with T2D starting tirzepatide or injectable semaglutide between May 13, 2022 and May 29, 2023. GLP-1 RA naïve and non-naïve cohorts were identified based on the history of GLP-1 RA use within ≤ 6 months of initiation. Propensity score matching balanced 6-month baseline characteristics between groups. HbA1c and weight changes were assessed from initiation to 12 months for matched patients with HbA1c and weight data at both time points. RESULTS: Both matched naïve cohorts were comprised of 10,702 patients (tirzepatide: 1399 with HbA1c data and 454 with weight data; semaglutide: 1173 with HbA1c data and 432 with weight data). Mean baseline HbA1c and weight were 7.8% and 112.4 kg, respectively, for the tirzepatide group and 7.8% and 110.7 kg for the semaglutide group. Both matched non-naïve cohorts were comprised of 5577 patients (tirzepatide: 792 with HbA1c data and 296 with weight data; semaglutide: 738 with HbA1c data and 224 with weight data). Mean baseline HbA1c and weight were 7.7% and 112.5 kg for tirzepatide, and 7.9% and 108.5 kg for semaglutide. Tirzepatide was associated with greater mean reductions in HbA1c (naïve: - 1.3% vs. - 0.9%; non-naïve: - 0.9% vs. - 0.6%; p < 0.001) and weight (naïve: - 10.2 kg vs. - 6.1 kg; non-naïve: - 7.9 kg vs. - 3.7 kg; p < 0.001) than semaglutide. CONCLUSIONS: Patients with T2D starting tirzepatide had greater HbA1c and weight reductions at 12 months post-initiation than those on injectable semaglutide, regardless of previous GLP-1 RA use, consistent with previous clinical trial results.