Semaglutide associated with lower stroke risk than empagliflozin

Patients taking semaglutide had a slightly lower risk of death or stroke than those taking empagliflozin, according to two target trial emulations based on observational data.

Researchers used data from one health system to match 7,899 patients ages 45 years or older with type 2 diabetes who were treated with semaglutide with 7,899 treated with empagliflozin. Patients were followed for a median of 2.2 years. The study was published by Annals of Internal Medicine on June 17.

On a composite outcome of death, myocardial infarction (MI), or stroke, rates were slightly lower with semaglutide at two years (3.7% vs. 4.5%) and at three years (5.9% vs. 6.9%). The hazard ratio (HR) for the composite outcome with semaglutide was 0.89 (95% CI, 0.78 to 1.02); HRs were 0.97 (95% CI, 0.81 to 1.15) for death, 0.85 (95% CI, 0.68 to 1.05) for MI, and 0.62 (95% CI, 0.43 to 0.89) for stroke. In a secondary trial analysis, 6,093 patients treated with dulaglutide were matched with 6,093 treated with empagliflozin, and the risk for death, MI, or stroke over follow-up did not differ significantly between groups.

The results “suggest that treatment with semaglutide (vs. empagliflozin) may be more beneficial for our primary composite outcome of death, MI, or stroke after an average of approximately 2 years of treatment, particularly among patients younger than 65 years,” said the study authors.

They noted that the effect was largely driven by a lower risk for stroke and also highlighted the finding that patients taking semaglutide had greater reductions in weight and HbA1c level than those taking empagliflozin. Limitations include the observational design of the study and the inclusion of a mostly White population, the authors noted. They suggested that studies such as this may be used to implement a precision medicine approach to diabetes medication prescribing.