SAN ANTONIO — Treatment with 2.4 mg of semaglutide once weekly (Wegovy) significantly reduced hospitalizations for all causes – not just cardiac – and overall length of hospital stay in people with overweight/obesity and those with diabetes. Established cardiovascular disease (CVD).

The new results come from prespecified analyzes of Novo-Nordisk’s multicenter, randomized SELECT trial, which showed that, compared to placebo, weekly administration of 2.4 mg of semaglutide significantly reduced the risk of cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) during the period. a mean follow-up of 39.8 months in 17,604 patients aged ≥ 45 years with overweight/obesity and established cardiovascular disease but not diabetes. THE main results SELECT were presented at the American Heart Association meeting in November 2023 and published simultaneously in the New England Journal of Medicine.

In the new analysis, presented Nov. 3 at the Obesity Society conference Obesity Week 2024 conference, people treated with semaglutide were 11% less likely to be hospitalized for any reason. Hospitalizations for cardiovascular causes were reduced by 17%, but people taking semaglutide also experienced significant reductions in hospitalizations for other causes, ranging from 15% to 24%.

“We regularly hear about the various benefits of GLP-1 receptor agonists (GLP-1 RAs). These SELECT analyzes add to this by now showing that even in people without diabetes, semaglutide has a benefit in reducing the risk of hospitalization that goes beyond simple cardiac causes,” presents author Steven E. Kahn, MB, ChB, professor of medicine and director of the Diabetes Research Center at the VA Puget Sound Health Care System, University of Washington, Seattle, said Medscape Medical News.

Although the average number of days per hospitalization was similar in the semaglutide and placebo groups, the lower total number of hospitalizations among those randomized to semaglutide meant that the total number of hospital days was reduced. “We have not done a formal cost analysis, but this benefit of semaglutide is expected to reduce hospitalization costs no matter where you are in the world,” Kahn said.

Obesity Society spokesperson Katherine H. Saunders, MD, of Weill Cornell Medicine in New York, commented: “What’s more expensive than Wegovy? A day in the hospital. This is a particularly important finding for health plans, employers and any full cost of care group – many of whom are concerned about Wegovy’s cost. Hopefully, this data will encourage more decision-makers to recognize not only the significant health benefits associated with Wegovy, but also the potential cost savings.

Session moderator Robert M. Siegel, MD, director of the Center for Better Health and Nutrition and professor in the department of pediatrics at the University of Cincinnati, Cincinnati, called the data “impressive” and agreed savings potential. “If you want to reduce hospitalizations as much as they seem to, that could potentially change the equation with these medications.” Few health economics studies really specify this, so this gives more data to be able to do it. The study is based on numerous figures.

However, Siegel also cautioned, “One should always take this with a grain of salt when it comes to funding funded by a pharmaceutical company. I would exercise some caution in interpreting the results. It’s hard to say how bias might affect the results. This was just the presentation and not the paper itself where we can really look at the nitty-gritty…but that by no means makes it a bad study. This seems pretty important.

Reduced hospitalizations for all causes, not just cardiovascular disease

During follow-up in the SELECT study, admissions, whatever the indication, occurred in 33.4% of cases with semaglutide compared to 36.7% with placebo (risk ratio: 0.89; P. < 0.0001) and admissions for serious adverse events (as opposed to elective procedures) occurred in 30.3% of cases with semaglutide compared to 33.4% with placebo (hazard ratio: 0.88; P. < 0.0001).

People taking semaglutide were less likely to be hospitalized for heart problems (10.4% versus 12.3%; relative risk, 0.83; P. < 0.0001), for infections/infestations (6.9% versus 8.0%; risk ratio: 0.85; P. = 0.004), surgical and medical interventions (4.6% versus 5.7%; relative risk, 0.81; P. = 0.001), and respiratory/thoracic/mediastinal disorders (1.9% versus 2.9%; relative risk, 0.66; P. < 0.0001).

The total number of hospitalizations was lower in the semaglutide group for all indications (18.3 versus 20.4 admissions per 100 patient years, relative risk 0.90; P. = .0002). The mean length of stay was similar between the semaglutide and placebo groups (13.0 versus 13.2 days; P. = 0.76), but the number of days of hospitalization per 100 patient-years was lower in the semaglutide group (157.2 versus 176.2 days; relative risk, 0.89; P. = 0.01).

Subgroup analyzes by sex, age and body mass index showed no differences in the effect of semaglutide.

However, Siegel pointed out that if people taking semaglutide lost more weight as the study progressed, that could contribute to differences in hospitalization rates. “The reason an obese patient is hospitalized can be very complicated. It’s a clinical decision, and a lot of things go into that clinical decision. And when the person is obese, there is a risk of doctor bias or concern about whether that person is taking care of themselves… But, while I think there may be some bias, what argues against this bias is that the length of stay was not different and this testifies to the seriousness of the illness.

In response to an audience member’s question along these lines, Kahn acknowledged, “We haven’t looked at these analyzes specifically to ask what the relationship is between the degree of weight loss and hospitalization.” It’s an interesting idea, and it’s something we can definitely consider as we move forward because we’re now in the process of starting to write this manuscript.

The study was funded by Novo Nordisk. Kahn serves on the advisory board/consultant of Abarceo Pharma, Amgen, AltPep, Anji, Biomea Fusion, Eli Lilly and Company, Merck, Neurimmune, Novo Nordisk and Oramed and receives research support from Corcept Therapeutics. He was a member of the SELECT steering committee. Saunders is the co-founder of FlyteHealth (a recent rebrand of Intellihealth; a software and clinical services company democratizing access to cost-effective medical treatment for obesity). She has no other disclosures. Siegel has no current disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape Medical News, and other work appears in the Washington Post, NPR’s Shots blog, and Diatribe. She’s on X @MiriamETucker.