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It found semaglutide reduced risk of major kidney events by 24% for type 2 diabetes patients, but GPs have urged caution.
Chronic kidney disease contributes to around 20,000 Australian deaths each year.
A small, weekly dose of semaglutide could prevent kidney failure and reduce deaths for those living with type 2 diabetes, according to a major new study.
The clinical trial, led by Australian researchers and published in the New England Journal of Medicine, found the medication, sold as Ozempic, could reduce the risk of kidney failure, as well as reducing the substantial loss of kidney function, and death from kidney or cardiovascular causes.
The trial involved more than 3500 participants with type 2 diabetes and chronic kidney disease (CKD) from 28 countries, including Australia, ultimately finding the dose of semaglutide reduced the risk of major kidney events by 24%.
The findings come amid a severe shortage of the drug thanks to its popularity as an off-label weight loss treatment.
This shortage first reached Australia in 2022, and the Therapeutic Goods Administration (TGA) expects it will last until at least the end of this year.
Patients are becoming so desperate for the product, last week the Federal Government announced an incoming ban on compounding pharmacies producing replicas of semaglutide and tirzepatide (sold as Mounjaro).
Around 20,000 Australian patients are currently injecting the replica products, with the majority using it for weight loss.
The study’s lead author Professor Vlado Perkovic described the benefits revealed in the trial as ‘greater than expected’, but acknowledged the chronic, worldwide shortage.
‘We would be saving kidneys, hearts and lives in this population by making this drug available to them and that’s quite extraordinary for one treatment to be able to do,’ he said.
‘We’re really starting to dramatically improve outcomes for people with diabetes and kidney disease. But that will only happen if the results are translated into action at the clinical coalface, so that’s an important next step.
‘The challenge is to get these results into clinical practice, to get the drug used by the people who will benefit from it, who will live longer without dialysis, without heart attacks, without strokes, if they take this drug.’
Conducted between June 2019 and May 2021, the trial saw half of all patients receiving a 1 mg dose of semaglutide each week, and half receiving a placebo.
Researchers said the lower dose was chosen as those with kidney disease can be more sensitive to the effects and side effects of drugs, but it could also allow semaglutide to be more widely used in the wake of its supply limitations.
The study found the drug worked to slow down loss of kidney function, lowered systolic blood pressure, and reduced body weight among participants.
The risk of cardiovascular events, such as heart attack and stroke, was also 18% lower for those on semaglutide, and risk of death from any cause was 20% lower.
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP the findings represent an expansion of treatment options beyond glucose management for these newer classes of therapies, including oral SGLT2i and GLP-1Ras.
‘These findings are limited to people with type 2 diabetes and moderate-to-severely increased albuminuria at the maximum 1 mg dose of semaglutide, so it represents a selected significant risk population within those parameters,’ he said.
‘Notably, the cardiovascular risks were reduced, which is a key issue with these people as cardiovascular disease death and morbidity is significantly higher than other people with diabetes without the kidney disease, and certainly those without diabetes altogether.
‘Standards of care for what is often an asymptomatic and advancing condition – CKD – gives hope and support that interventions may assist health outcomes that might have been severe if not previously treatable.’
The research comes as diabetes continues to be one of the most common causes of kidney disease.
According to the Australian Institute of Health and Welfare, CKD contributes to around 20,000 Australian deaths each year, about 12% of all fatalities.
Dr Deed said given the popularity of semaglutide as a weight-loss treatment, the research highlights the importance of ensuring enough is available for those needing it to treat diabetes.
‘But remember, this evidence still needs to be filtered through our TGA and this indication is not currently supported here in Australia,’ he said.
And while Dr Deed welcomed last week’s compounding ban, describing the off-label trend as a ‘sideshow of inappropriate, poorly regulated supply of an injectable medication’, he said much more needs to be done.
He said this includes better planning with company supply chains and better communication to clinicians to ensure patients are not going without.
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diabetes kidney disease medicine shortages Ozempic semaglutide TGA Therapeutic Goods Administration
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