In an ASHP Midyear 2023 Clinical Meeting & Exhibition Management Case Study titled “Another Great Debate—Semaglutide versus Tirzepatide for Type 2 Diabetes and Obesity,” Jennifer N. Clements, PharmD, BCACP, BC-ADM, BCPS, CDCES, FADCES, FCCP, clinical professor and director of pharmacy education, University of South Carolina College of Pharmacy, and Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, endocrine clinical pharmacy specialist, Cleveland Clinic Diabetes Center, compared the benefits, risks, and barriers of both semaglutide and tirzepatide for type 2 diabetes (T2D) and obesity based on recommendations from the American Diabetes Association.
Dr. Clements kicked off the session by describing diabetes as a “chronic condition,” adding that she wanted “people to feel empowered to be able to self-manage at home using various strategies and management tips.” In addition to historical T2D treatments (i.e., metformin, sulfonylureas, thiazolidinediones, acarbose, glitinides, and insulin), there have been additional therapeutic classes, such as semaglutide and tirzepatide, that, as Dr. Clements describes, “allows us to personalize, individualize, and strive for A1C [hemoglobin A1C] reduction but also lower the risk of micro- and macrovascular complications.”
In terms of glycemic management, semaglutide and tirzepatide are both listed as “very high” efficacy, according to the 2023 Standards of Care in Diabetes. In addition, these medications are also listed as “very high” efficacy in the weight management category.
Dr. Clements presented her data for the use of the glucagon-like peptide-1 (GLP-1) receptor agonist (RA), semaglutide (for this session, she referenced only the SC formulation). According to results from the SUSTAIN-6 trial, she noted that semaglutide:
• Has a high efficacy for A1C reduction
• Has a low risk of hypoglycemia
• Has a “very high” effect on weight loss
• Assists in a modest reduction of blood pressure
• Has a cardiovascular disease (CVD) reduction, as well as positive stroke and renal outcomes, in those with T2D and established CVD.
Dr. Isaacs also presented her data for the use of the dual glucose-dependent insulinotropic polypeptide/GLP-1 RA, tirzepatide. According to results from the SURPASS and SURMOUNT clinical trials, she noted that tirzepatide has similar results to semaglutide trials; however, results from the cardiovascular study (SURPASS-CVOT) would not be available until 2024. She anticipates those will be positive as well.
Some key takeaways from the session included:
• Developing a person-centered plan for glycemic and weight management based on drug- and person-specific factors• Customizing the plan based on clinical evidence for glycemic and weight management
• Validating change in culture and promoting evidence-based recommendations from clinical trials and practice guidelines/standards to justify specific therapy for people with T2D and obesity.
In conclusion, Dr. Isaacs spoke about both semaglutide and tirzepatide as “two incredible options” with their capabilities of lowering A1C, of reducing weight, and of having positive CV outcome data.
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