Efficacy of once-weekly semaglutide vs empagliflozin added to metformin in type 2 diabetes: patient-level meta-analysis.

Context No head-to-head trials have directly compared once-weekly (OW) semaglutide, a human glucagon-like peptide-1 analog, with empagliflozin, a sodium-glucose cotransporter-2 inhibitor, in type 2 diabetes (T2D). Objective We indirectly compared the efficacy of OW semaglutide 1 mg vs once-daily (OD) empagliflozin 25 mg in patients with T2D inadequately controlled on metformin monotherapy, using individual patient data (IPD) and meta-regression (MR) methodology. Design, setting, participants and interventions IPD for patients with T2D receiving metformin monotherapy and randomized to OW semaglutide 1 mg (SUSTAIN 2, 3, 8 trials), or to OD empagliflozin 25 mg (PIONEER 2 trial) were included. MR analyses adjusted for potential prognostic factors and effect modifiers. Main outcome measures The primary efficacy outcomes were change from baseline to end of treatment (~1 year) in HbA1c (%-point) and body weight (kg). Responder outcomes and other clinically relevant efficacy measures were analyzed. Results Baseline characteristics were similar between OW semaglutide (n=995) and empagliflozin (n=410). Our analyses showed that OW semaglutide significantly reduced mean HbA1c and body weight vs empagliflozin (estimated treatment difference: -0.61%-point [95% confidence interval [CI]: -0.72;-0.49] and -1.65 kg [95% CI: -2.22;-1.08], respectively; both p&0.0001). Complementary analyses supported the robustness of these results. A significantly greater proportion of patients on OW semaglutide vs empagliflozin also achieved HbA1c targets and weight-loss responses. Conclusions This indirect comparison suggests that OW semaglutide 1 mg provides superior reductions in HbA1c and body weight vs OD empagliflozin 25 mg in patients with T2D when added to metformin monotherapy.