Semaglutide 2.4 mg Reduces All-Cause Hospital Admissions

SAN ANTONIO — Treatment with once-weekly semaglutide 2.4 mg (Wegovy) significantly reduced hospital admissions for all causes — not just cardiac — and overall hospitalization time in people with overweight/obesity and established cardiovascular disease (CVD).

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

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

“We hear regularly about different benefits of GLP-1 receptor agonists (GLP-1 RA). These analyses from SELECT adds to that in now showing that even in people without diabetes, semaglutide has a benefit to reduce the risk of hospitalization that goes beyond just cardiac causes,” presenting 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, told Medscape Medical News.

While the average number of days per hospitalization was similar in the semaglutide and placebo groups, the lower number of total hospitalizations in those randomized to receive semaglutide meant that overall days in the hospital were reduced. “We have not performed a formal cost analysis, but this benefit with semaglutide would be expected to reduce the costs for hospitalizations no matter where in the world one is located,” Kahn said.

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

Session moderator Robert M. Siegel, MD, director of the Center for Better Health and Nutrition and professor in the University of Cincinnati Department of Pediatrics, Cincinnati, called the data “impressive” and agreed with the cost-saving potential. “If you’re going to reduce hospitalizations as much as they seem to, that could potentially change the equation with these medications. Not a lot of the health economic studies really fine-tune that, so this gives more data to be able to do that. There are a lot of numbers to the study.”

However, Siegel also cautioned, “One must always take it with a grain of salt when it’s drug company funded. I would use some caution interpreting the results. It’s hard to say how biases might affect the outcomes. This was just the presentation and not the actual paper where we really get to look at the nuts and bolts…but that doesn’t make it a bad study in any way. It looks pretty significant.” 

Hospitalizations Reduced for All Causes, not Just Cardiovascular-Related 

During follow-up in SELECT, admissions for any indication occurred in 33.4% with semaglutide vs 36.7% with placebo (hazard ratio, 0.89; P P

Those on semaglutide were less likely to be hospitalized for cardiac disorders (10.4% vs 12.3%; hazard ratio, 0.83; P P = .004), surgical and medical procedures (4.6% vs 5.7%; hazard ratio, 0.81; P = .001), and respiratory/thoracic/mediastinal disorders (1.9% vs 2.9%; hazard ratio, 0.66; P

Numbers of total hospitalizations were lower in the semaglutide group for all indications (18.3 vs 20.4 admissions per 100 patient years, hazard ratio, 0.90; P = .0002). The mean length of stay was similar between the semaglutide and placebo groups (13.0 vs 13.2 days; P = .76), but the number of days hospitalized per 100 patient years was lower in the semaglutide group (157.2 vs 176.2 days; risk ratio, 0.89; P = .01).

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

However, Siegel pointed out that if the people taking semaglutide lost more weight as the study progressed, that could contribute to differences in hospitalization rates. “Why a patient with obesity gets hospitalized can be very complicated. That’s a clinical decision, and a lot goes into that clinical decision. And when the person’s obese, there is a potential for physician bias or concerns about whether this person take care of themselves…But, while I do think there may be some bias, what argues against the bias is that the duration of stay wasn’t different and that speaks to the severity of illness.” 

In response to an audience member’s question along those lines, Kahn acknowledged, “We have not 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 certainly can consider as we go forward because we’re now in the process of starting to write this manuscript.”

The study was funded by Novo Nordisk. Kahn serves as an advisory panel member/consultant for 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 has been a member of the SELECT Steering Committee. Saunders is the co-founder of FlyteHealth (a recent rebrand from Intellihealth; a software and clinical services company democratizing access to cost-effective medical obesity treatment). She has no further 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, with other work appearing in The Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker.