Target Trial of Semaglutide Versus Dulaglutide or Liraglutide in Patients Receiving Hemodialysis
Dustin Le, Evan Forman, Walter K. Kraft, Morgan E. Grams, Bernard G. Jaar, Jung-Im ShinOBJECTIVE
To evaluate the comparative effectiveness of semaglutide versus dulaglutide or liraglutide in patients with diabetes receiving maintenance hemodialysis.
RESEARCH DESIGN AND METHODS
Using 2011–2022 U.S. Renal Data System and Medicare data, we emulated a target trial evaluating semaglutide versus dulaglutide or liraglutide in patients receiving hemodialysis. Overlap weights were used to adjust for confounders. Fine-Gray models were used to assess death on dialysis and hospitalization. A generalized estimating equation was used for repeated measures of body weight.
RESULTS
We identified 1,312 semaglutide and 2,601 dulaglutide or liraglutide users. After overlap weighting, the effective sample size was 3,200 patients (mean age 61; 63% White; 28% Black; 52% male; median [interquartile range] BMI 34 [29–40] kg/m2; median follow-up 1.1 [0.6–1.9] years). Semaglutide versus dulaglutide or liraglutide was associated with a mortality on dialysis subdistribution hazard ratio (sHR) of 0.82 (95% CI 0.70–0.97; 1-year cumulative incidence 11% vs. 13%) and all-cause hospitalization sHR of 0.91 (95% CI 0.83–0.99; 1-year incidence 57% vs. 62%). Body weight loss was higher with semaglutide (−4.8%, 95% CI −5.3% to −4.2%) at 1 year vs. −3.4%, 95% CI −3.9% to −3.1%). Direct comparisons of semaglutide versus dulaglutide showed similar results for mortality (sHR 0.82, 95% CI 0.69–0.97) and hospitalization (sHR 0.88, 95% CI 0.81–0.97), but semaglutide versus liraglutide showed no statistically significant benefit for mortality or hospitalization.
CONCLUSIONS
Among patients with diabetes receiving hemodialysis and equipoise between semaglutide and dulaglutide or liraglutide, semaglutide may be the preferred glucagon-like peptide 1 agent compared with dulaglutide.