Semaglutide (Ozempic), a new once-weekly injectable glucagon-like peptide 1 receptor agonist (GLP-1 RA), is now available for type 2 diabetes.

Semaglutide is used alongside diet and exercise as monotherapy when metformin is inappropriate due to intolerance or contraindications. It can be added to other antidiabetic drugs when type 2 diabetes is insufficiently controlled.

Manufacturer Novo Nordisk remarks that in clinical studies, semaglutide produces superior glycaemic control and weight loss compared with dulaglutide, exenatide once weekly, sitagliptin and insulin glargine U100. Semaglutide offers cardiovascular benefits compared with placebo (added to standard of care) in type 2 diabetes patients at high cardiovascular risk.

Patients begin with 0.25mg once a week for four weeks, followed by 0.5mg once a week. After at least four weeks, the dose can increase to 1.0mg once-weekly if needed. Novo Nordisk says semaglutide “can be prescribed at no additional cost compared to other onceweekly GLP-1 RAs”.

Some preclinical studies associate GLP-1 RAs with an increased risk of thyroid cancer but the latest results are reassuring. “It is important to note that the known class effects of GLP-1 RA on thyroid C-cell hyper- and neoplasia have only been observed in rodents during preclinical animal studies,” Avideh Nazeri, director of clinical, medical and regulatory for Novo Nordisk UK, told Pharmacy Magazine.

“Based on the totality of available data, the human relevance of this effect is considered to be low and in the case of semaglutide is consistent with all other medicines in the class,” Dr Nazeri added. “Across the semaglutide development programme, including more than 4,700 subjects randomised to semaglutide, no medullary thyroid cancers [MTC] were identified.

“However, GLP-1 analogues are contraindicated in people with, or with a history of, MTC. In line with European pharmacovigilance legislation, Novo Nordisk continuously performs ongoing safety surveillance across all of our products, and so surveillance will continue on semaglutide.”