New data from an exploratory post hoc analysis of the SELECT trial indicates that semaglutide 2.4 mg significantly reduces hospital admissions and the length of hospital stays for adults with obesity or overweight and established cardiovascular disease (CVD), but without diabetes. The findings, presented at ObesityWeek®, build on the SELECT trial's primary outcome, which demonstrated a reduction in major adverse cardiovascular events (MACE) with semaglutide 2.4 mg in this population.
Cardiovascular disease remains the leading cause of death globally, with obesity recognized as a major risk factor. The SELECT trial aimed to evaluate the efficacy of semaglutide 2.4 mg in reducing cardiovascular events in individuals with pre-existing CVD and either overweight or obesity. The new analysis focused on the impact of semaglutide on hospital admissions.
Impact on Hospital Admissions
The SELECT analysis revealed that a smaller percentage of patients treated with semaglutide 2.4 mg experienced a first hospital admission for any reason compared to those receiving placebo (33.4% vs 36.7%, hazard ratio [HR] 0.89 [0.84, 0.93], p<0.0001). A similar reduction was observed for serious adverse events (30.3% vs 33.4%, HR 0.88 [0.84, 0.93], p<0.0001).
Furthermore, the total number of hospitalizations was lower in the semaglutide group compared to the placebo group for all indications (18.3 vs 20.4 admissions per 100 patient years, HR 0.90 [0.85, 0.95], p=0.0002) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient years, HR 0.89 [0.84, 0.94], p<0.0001).
Reduction in Hospital Stay Duration
The analysis also demonstrated a reduction in the number of days hospitalized per 100 patient years in the semaglutide 2.4 mg group. For all hospitalizations, the semaglutide group experienced 157.2 days compared to 176.2 days in the placebo group (risk ratio [RR] 0.89 [0.82, 0.98], p=0.01). Hospitalizations related to serious adverse events also showed a reduction, with 137.6 days in the semaglutide group versus 153.9 days in the placebo group (RR 0.89 [0.81, 0.98], p=0.02).
Expert Commentary
"People with obesity or overweight with established cardiovascular disease (CVD) and without diabetes are more likely to be admitted to the hospital for events like heart attack or stroke, contributing to reduced patient well-being, higher use of healthcare resources, and disease burden," said Dr. Steven E. Kahn, M.D., Ch.B., Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle. "In the SELECT trial, this cohort of patients had a high rate of hospital admissions, but for those given once-weekly semaglutide 2.4 mg, we observed significant reductions in hospital admissions and overall time they spent in the hospital. We are pleased to have this analysis that further examines the effects of semaglutide."
SELECT Trial Details
The SELECT trial was a multicenter, randomized, double-blind, placebo-controlled trial involving 17,604 adults across 41 countries. It evaluated semaglutide 2.4 mg versus placebo as an adjunct to cardiovascular standard of care for reducing the risk of major adverse cardiovascular events in people with established CVD with overweight or obesity and no prior history of diabetes.
Safety Profile
In the SELECT trial, serious adverse events were reported in 33.4% of patients randomized to semaglutide 2.4 mg and 36.4% of patients receiving placebo. Sixteen percent of semaglutide-treated patients and 8% of placebo-treated patients discontinued the study drug due to an adverse event, with gastrointestinal disorders being the most common cause of discontinuation (10% in the semaglutide group and 2% in the placebo group).
Implications for Clinical Practice
These findings suggest that semaglutide 2.4 mg may offer benefits beyond cardiovascular risk reduction in patients with obesity or overweight and established CVD. The observed reductions in hospital admissions and length of stay could have significant implications for healthcare resource utilization and patient well-being. Further research is warranted to confirm these findings and explore the mechanisms underlying the observed effects.
