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Episode #3: The new GLP-1 kid on the block - Semaglutide!

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Manage episode 205388017 series 2158906
Content provided by Disgruntled Dan. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Disgruntled Dan or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.

Disgruntled Dan’s Conclusions:

    Semaglutide reduces the risk of nonfatal stroke (NNT 97 for 2.1 years), new or worsening nephropathy (NNT 43 over 2.1 years), and revascularization. Yes – there was a reduction in the composite MACE outcomes, but this was primarily driven by the results from nonfatal strokes. Use with caution in patients that currently have retinopathies – Semaglutide may worsen and/or cause retinopathies and the exact cause is currently unknown. Once weekly dosing – convenient for the patient. Start low and go slow, it is a once weekly injection. Due to the long half life it is recommended you start at 0.25mg x 4 weeks THEN 0.5mg x 4 weeks THEN increase to max dose of 1mg. Cost ~$700 for a 4-6 week supply without insurance. It is a new drug. We do not have much experience with it. So I am always cautiously optimistic but I will generally choose options that we have a bit more real world data with before jumping to this. In reality it comes down to that patient sitting in front of you. Remember to keep it patient centred!

References

    Marso, S. P. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N. Engl. J. Med. 375, 1834–1844 (2016). Fda, Cder & buckmans. Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry. (2016). Sorli, C. et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. lancet. Diabetes Endocrinol. 5, 251–260 (2017). Dungan, K. & DeSantis, A. Glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes mellitus - UpToDate. Available at: https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?search=glp 1&source=search_result&selectedTitle=1~106&usage_type=default&display_rank=1. (Accessed: 6th May 2018) Guyatt, G., Rennie, D., Meade, M. & Cook, D. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed | JAMAevidence | McGraw-Hill Medical. Available at: https://jamaevidence.mhmedical.com/Book.aspx?bookId=847. (Accessed: 6th May 2018)
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4 episodes

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iconShare
 

Archived series ("HTTP Redirect" status)

Replaced by: Disgruntled Dan's Pharmacy Podcast

When? This feed was archived on June 28, 2018 09:27 (6y ago). Last successful fetch was on June 12, 2018 02:04 (6y ago)

Why? HTTP Redirect status. The feed permanently redirected to another series.

What now? If you were subscribed to this series when it was replaced, you will now be subscribed to the replacement series. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.

Manage episode 205388017 series 2158906
Content provided by Disgruntled Dan. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Disgruntled Dan or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.

Disgruntled Dan’s Conclusions:

    Semaglutide reduces the risk of nonfatal stroke (NNT 97 for 2.1 years), new or worsening nephropathy (NNT 43 over 2.1 years), and revascularization. Yes – there was a reduction in the composite MACE outcomes, but this was primarily driven by the results from nonfatal strokes. Use with caution in patients that currently have retinopathies – Semaglutide may worsen and/or cause retinopathies and the exact cause is currently unknown. Once weekly dosing – convenient for the patient. Start low and go slow, it is a once weekly injection. Due to the long half life it is recommended you start at 0.25mg x 4 weeks THEN 0.5mg x 4 weeks THEN increase to max dose of 1mg. Cost ~$700 for a 4-6 week supply without insurance. It is a new drug. We do not have much experience with it. So I am always cautiously optimistic but I will generally choose options that we have a bit more real world data with before jumping to this. In reality it comes down to that patient sitting in front of you. Remember to keep it patient centred!

References

    Marso, S. P. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N. Engl. J. Med. 375, 1834–1844 (2016). Fda, Cder & buckmans. Non-Inferiority Clinical Trials to Establish Effectiveness Guidance for Industry. (2016). Sorli, C. et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. lancet. Diabetes Endocrinol. 5, 251–260 (2017). Dungan, K. & DeSantis, A. Glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes mellitus - UpToDate. Available at: https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus?search=glp 1&source=search_result&selectedTitle=1~106&usage_type=default&display_rank=1. (Accessed: 6th May 2018) Guyatt, G., Rennie, D., Meade, M. & Cook, D. Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed | JAMAevidence | McGraw-Hill Medical. Available at: https://jamaevidence.mhmedical.com/Book.aspx?bookId=847. (Accessed: 6th May 2018)
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