Both agents were efficacious in the older population, Dr. Aroda said, with slightly better efficacy than in younger patients. As a caveat, she noted that the older patients came into the study with slightly better glycemic control and slightly lower body weight.
An array of endpoints for the 40-week study included achieving hemoglobin A1c less than 7%, less than or equal to 6.5%, and less than 7% without weight gain or hypoglycemia. A higher proportion of elderly patients met these endpoints; for example, 83% of elderly patients on high-dose semaglutide reached the composite endpoint of HbA1c less than 7% with no weight gain or hypoglycemia, compared to 72.1% of younger participants.
The analysis also looked at safety data for SUSTAIN 7. “The next question is, are you seeing this efficacy in terms of glycemic change and weight loss, at any cost of hypoglycemia? And the answer to that was no,” said Dr. Aroda. There were very rare to zero hypoglycemic events in the various study arms, she said.
However, older adults taking the higher doses of both GLP-1 receptor agonists had a high incidence of nausea, vomiting, and other gastrointestinal disturbances. These adverse events were seen in 52.8% of older patients on high-dose semaglutide and 52.2% of those on high-dose dulaglutide. Rates for the younger study population at these doses were 42.5% for semaglutide and 46.6% for dulaglutide.