12th July 2020, Dr Chee L Khoo
One month ago, we discussed Ozempic®(semaglutide) as the new GLP-1 agonist kid on the block in the treatment of hyperglycaemia in patients with type 2 diabetes (T2D). We foreshadowed that it will be coming real soon. Well, sooner than I thought. Ozempic® went on the PBS on the 1st July. What we didn’t know was what the restrictions will be when prescribing for patients with T2D.
Ozempic® is available on the PBS as a streamline authority for patients with T2D with the following clinical criteria:
- Must be used with metformin +/- sulphonylureas or
- Intolerant of metformin +/- sulphonylureas and
- Have a HbA1c >7.0%
Ozempic® cannot be prescribed under the PBS in conjunction with insulin, a DPP4 inhibitor, a thiazolidinedione or an SGLT2 inhibitor.
International guidelines now recommend GLP-1 agonist therapy for cardiovascular risk protection in patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) or multiple ASCVD risk factors, independent of glucose control or background antihyperglycemic therapy (other diabetes medications being used). In patients with advanced chronic kidney disease (CKD), our options for treatment of hyperglycaemia are quite limited. Most DPP4 inhibitors and all SGLT2 inhibitors are no longer indicated once eGFR drops below 45.
In a recent review of cardiovascular outcome trials (CVOT), long acting GLP-1 agonists (albuglutide (not available yet), dulaglutide, liraglutide and semaglutide) were found to be safe, well tolerated, and improve cardiovascular outcomes, largely independent of their anti-hyperglycaemic properties, but they remain underused.
The availability of Ozempic® on the PBS should trigger a review of all our patients with T2D who has established ASCVD or multiple ASCVD risk factors. It is imperative that we review our patients’ anti-diabetic regimen irrespective of glycaemic control. Which ones of your patients with cardio-renal complications could benefit from a GLP-1 agonist in reducing their cardiovascular event risk?
Honigberg MC, Chang L, McGuire DK, Plutzky J, Aroda VR, Vaduganathan M. Use of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Review. JAMA Cardiol. Published online June 17, 2020. doi:10.1001/jamacardio.2020.1966