Real-world use of oral semaglutide in adults with type 2 diabetes: the PIONEER REAL Switzerland multicentre, prospective, observational study

Introduction Real-world data provide insight into how medications perform in clinical practice. PIONEER REAL Switzerland aimed to understand clinical outcomes with oral semaglutide in adults with type 2 diabetes (T2D). Methods PIONEER REAL Switzerland was a 34–44-week, multicentre, prospective, non-interventional, single-arm study of adults with T2D naïve to injectable glucose-lowering medication who were initiated on oral semaglutide in routine clinical practice. The primary endpoint was change in HbA1c from baseline (BL) to end of study (EOS); secondary endpoints included change in body weight (BW) from BL to EOS and the proportion of participants achieving HbA1c <7.0% and the composite endpoints HbA1c reduction ≥1% with BW reduction ≥3% or ≥5% at EOS. Safety was assessed in participants who received ≥1 dose of oral semaglutide. Results 185 participants (female/male, n = 67/118) initiating oral semaglutide, 168 (90.8%) completed the study and 143 (77.3%) remained on treatment with oral semaglutide at EOS. At BL, participants had a mean age of 62 years, diabetes duration of 6.4 years, HbA1c of 7.7%, BW of 95.6 kg and body mass index of 33.2 kg/m2; 56.2% of participants were receiving glucose-lowering medications. Significant reductions were observed for HbA1c (estimated change [95% confidence interval (CI)] −0.91% [−1.10, −0.71]; p < 0.0001), as well as BW (estimated change [95% CI] −4.85% [−5.70, −4.00]; p < 0.0001). In total, 139 adverse events (AEs) were reported in 65 (35.1%) participants; most were mild or moderate. The most frequent were gastrointestinal disorders (27.0%), and 31 AEs in 20 (10.8%) participants led to discontinuation of oral semaglutide. Six serious AEs were reported; all were considered unlikely to be related to oral semaglutide. Conclusion People living with T2D treated with oral semaglutide in Switzerland achieved clinically significant reductions in HbA1c and BW, with no new safety signals.