Combined Semaglutide and Sodium–Glucose Cotransporter-2 Inhibitor Use and Metabolic Outcomes in Chinese Adults With Diabetes: Post Hoc Analysis

INTRODUCTION: Real-world use of once-weekly semaglutide in adults with type 2 diabetes in China has been shown in SCHOLAR. This post hoc analysis investigated the use of combination semaglutide-sodium-glucose cotransporter-2 inhibitor (SGLT2i) treatment, glycated hemoglobin (HbA1c) changes, and safety in a subset of SCHOLAR participants. METHODS: Participants from SCHOLAR were included in this post hoc, single-arm analysis if they were prescribed once-weekly subcutaneous semaglutide and had ≥ 1 SGLT2i prescription within 6 months of initiating semaglutide. Participants were grouped according to whether semaglutide use was continuous or not and by baseline HbA1c (≥ 7%). We evaluated the proportion of SCHOLAR participants prescribed combined semaglutide-SGLT2i. Key endpoints were: change in HbA1c from baseline to month 6; proportion of participants achieving a HbA1c level < 7% at month 6; change in lipid profile from baseline to month 6; and safety profile of combined semaglutide-SGLT2i. RESULTS: A total of 11,361 (42.3%) SCHOLAR participants were treated with combined semaglutide-SGLT2i. Mean change in HbA1c (95% confidence interval [CI]) from baseline to month 6 was - 0.64%-points (- 0.71, - 0.56) (p < 0.0001) for the overall combined semaglutide-SGLT2i group. The greatest change was seen in the continuous semaglutide group with baseline HbA1c ≥ 7% (- 1.20%-points [95% CI - 1.36, - 1.04]). The proportion of participants with HbA1c levels < 7% increased from 37.8% at baseline to 55.1% at month 6 for the overall combined treatment group. There were significant reductions in mean total cholesterol (p < 0.0001), low-density lipoprotein cholesterol (p < 0.0001), and triglycerides (p = 0.0043) as well as a significant increase in high-density lipoprotein cholesterol (p < 0.0001). Gastrointestinal adverse events were most frequent. CONCLUSIONS: Combined semaglutide-SGLT2i treatment was prevalent in this subset of the SCHOLAR population and associated with significant reduction in HbA1c and changes in lipid profile. The safety profile of combined semaglutide-SGLT2i was similar to the overall SCHOLAR population. TRIAL REGISTRATION NUMBER: NCT06351748.