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Semaglutide improves renal outcomes in overweight/obese participants with cardiovascular disease and no diabetes

Presented by
Prof. Helen M. Colhoun, The University of Edinburgh, United Kingdom
ERA 2024
Phase 3, SELECT
Semaglutide compared with placebo showed significant renal improvement on top of the recently established cardiovascular improvements in participants with overweight/obesity and cardiovascular disease enrolled in the SELECT trial.

The SELECT study (NCT03574597) is a randomised, double-blind, multicentre, phase 3 trial of semaglutide versus placebo which enrolled participants with BMI ≥27 kg/m2 and established cardiovascular disease but no diabetes to assess cardiovascular outcomes [1]. The current renal prespecified analysis, presented by Prof. Helen M. Colhoun (The University of Edinburgh, United Kingdom), used a composite endpoint defined as death due to kidney causes, initiation of chronic kidney replacement therapy (dialysis or transplant), onset of persistent eGFR <15 mL/min/1.73 m2, persistent eGFR reduction from baseline of ≥50%, or onset of persistent albuminuria. These analyses were performed on the entire cohort of SELECT (n=17604) [2].

The time-to-occurrence of the 5-component kidney endpoint was significantly longer with semaglutide compared with placebo. After a median follow-up of 182 weeks, 1.8% of participants receiving semaglutide and 2.2% receiving placebo achieved the composite endpoint (HR 0.78; 95% CI 0.63–0.96; P=0.02). When analysing the individual components of the composite endpoint, the efficacy results were mainly driven by improvement in time-to-onset of eGFR reduction from baseline of ≥50% (HR 0.57; 95% CI 0.27–1.14; P=0.11) and time-to-onset of microalbuminuria (HR 0.80; 95% CI 0.64–1.00; P=0.05). No kidney-related deaths were observed for either group. Finally, semaglutide led to a treatment benefit of 0.75 mL/min/1.73 m2 (95% CI 0.43–0.96; P<0.001) in eGFR and -10.7% (95%CI -13.2 to -8.2; P<0.001) in urinary albumin-creatinine ratio at week 104, compared with placebo.

“In the absence of diabetes, 2.4 mg of semaglutide weekly reduced the composite kidney endpoint by 22% and had beneficial effects on eGFR and urine albumin-creatinine ratio”, summarised Prof. Colhoun. “These data add to the growing body of evidence on the potential kidney benefit of semaglutide”.

  1. Lincoff AM, et al. N Engl J Med 2023;389(24):2221-2232.
  2. Colhoun HM, et al. Effect of semaglutide on kidney outcomes in people with overweight or obesity and established cardiovascular disease in the SELECT trial. Abstract #2496, ERA 2024, 23–26 May, Stockholm, Sweden.

Medical writing support was provided by Mihai Surducan, PhD.

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