A new secondary analysis of the SELECT trial pushes back on the instinct for avoiding new semaglutide prescriptions in frail patients after finding that the drug delivered its CV benefits regardless of frailty.
- Clinicians often hesitate to start frail patients on new medications, worried the risks outweigh the benefits due to potential for intolerance or adverse safety outcomes.
- That hesitation is also true for Novo’s Wegovy (semaglutide) since it can aggressively reduce body mass, and in some cases muscle mass.
With how new GLP-1s still are, it’s worth testing if they fit the frailty mold. Thus, researchers analyzed 17.6k patients from SELECT with CVD and overweight/obesity, but without diabetes and sorted them into three frailty categories finding that…
- Semaglutide’s effect on CV death, nonfatal MI, and nonfatal stroke was consistent across all three frailty categories.
- That also held true for HF outcomes, with all-cause hospitalization, and all-cause mortality showing no meaningful difference due to frailty.
- Notably, the frailest patients had the highest baseline negative event rates, meaning they had the most risk to reduce.
However, the quality-of-life and safety findings are where frailty matters most, and in this case, Semaglutide shined.
- Improvement in health-related QoL was greater in patients with higher frailty.
- The frailest patients taking semaglutide were more likely to see their frailty improve (OR: 2.46) and less likely to see it worsen (OR: 0.47) over 104 weeks.
- Counterintuitively, adverse events leading to treatment discontinuation were lower in frailer patients on semaglutide than placebo.
The clinical trend in these data makes it seem like there isn’t a good reason to withhold GLP-1 therapy from frail patients.
- If anything, this subanalysis argues that frailer patients may stand to gain the most from semaglutide, both in outcomes and in day-to-day functioning.
- That said, this analysis doesn’t show why this happens, just that it does.
The Takeaway
Sometimes a new drug challenges the old way of doing things, and when it comes to CVD and frailty, Semaglutide is doing just that. Clinicians can rest a little easier now when considering GLP-1s for their frailest patients.
