Cited by 995Pharmacology and Obesity TreatmentDiabetes Treatment and ManagementRegulation of Appetite and Obesity

Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial

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Rubino, Domenica M., Greenway, Frank L., Khalid, Usman, O’Neil, Patrick M., Rosenstock, Julio, Sørrig, Rasmus, Wadden, Thomas A., Wizert, Alicja +15 more·2022·JAMA

Abstract

Importance: Phase 3 trials have not compared semaglutide and liraglutide, glucagon-like peptide-1 analogues available for weight management. Objective: To compare the efficacy and adverse event profiles of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg (both with diet and physical activity), in people with overweight or obesity. Design, Setting, and Participants: Randomized, open-label, 68-week, phase 3b trial conducted at 19 US sites from September 2019 (enrollment: September 11-November 26) to May 2021 (end of follow-up: May 11) in adults with body mass index of 30 or greater or 27 or greater with 1 or more weight-related comorbidities, without diabetes (N = 338). Interventions: Participants were randomized (3:1:3:1) to receive once-weekly subcutaneous semaglutide, 2.4 mg (16-week escalation; n = 126), or matching placebo, or once-daily subcutaneous liraglutide, 3.0 mg (4-week escalation; n = 127), or matching placebo, plus diet and physical activity. Participants unable to tolerate 2.4 mg of semaglutide could receive 1.7 mg; participants unable to tolerate 3.0 mg of liraglutide discontinued treatment and could restart the 4-week titration. Placebo groups were pooled (n = 85). Main Outcomes and Measures: The primary end point was percentage change in body weight, and confirmatory secondary end points were achievement of 10% or more, 15% or more, and 20% or more weight loss, assessed for semaglutide vs liraglutide at week 68. Semaglutide vs liraglutide comparisons were open-label, with active treatment groups double-blinded against matched placebo groups. Comparisons of active treatments vs pooled placebo were supportive secondary end points. Results: Of 338 randomized participants (mean [SD] age, 49 [13] years; 265 women [78.4%]; mean [SD] body weight, 104.5 [23.8] kg; mean [SD] body mass index, 37.5 [6.8]), 319 (94.4%) completed the trial, and 271 (80.2%) completed treatment. The mean weight change from baseline was -15.8% with semaglutide vs -6.4% with liraglutide (difference, -9.4 percentage points [95% CI, -12.0 to -6.8]; P < .001); weight change with pooled placebo was -1.9%. Participants had significantly greater odds of achieving 10% or more, 15% or more, and 20% or more weight loss with semaglutide vs liraglutide (70.9% of participants vs 25.6% [odds ratio, 6.3 {95% CI, 3.5 to 11.2}], 55.6% vs 12.0% [odds ratio, 7.9 {95% CI, 4.1 to 15.4}], and 38.5% vs 6.0% [odds ratio, 8.2 {95% CI, 3.5 to 19.1}], respectively; all P < .001). Proportions of participants discontinuing treatment for any reason were 13.5% with semaglutide and 27.6% with liraglutide. Gastrointestinal adverse events were reported by 84.1% with semaglutide and 82.7% with liraglutide. Conclusions and Relevance: Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity, resulted in significantly greater weight loss at 68 weeks. Trial Registration: ClinicalTrials.gov Identifier: NCT04074161.

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Crossref · 10.1001/jama.2021.23619

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  • In four studies (n = 3087), semaglutide led to a greater percentage of trial discontinuations due to gastrointestinal adverse events relative to placebo (RR 5.36 [95% CI 2.49, 11.55]; P < 0.0001).

    “Furthermore, four studies (n = 3087) 16,17,19,20 revealed that semaglutide led to a greater percentage of trial discontinuations due to GI AEs relative to placebo (RR 5.36, [95% CI 2.49, 11.55]; P &lt; 0.0001 [Figure S16]).”

    From Efficacy and safety of semaglutide 2.4 mg for weight loss in overweight or obese adults without diabetes: An updated systematic review and meta‐analysis including the 2‐year <scp>STEP</scp> 5 trial (2024) · cites this paper as [20]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Similar differences in effectiveness are found when looking at reductions in waist circumference, systolic blood pressure, and serum triglycerides, with differences in effect sizes reflecting the differences in weight loss in response to liraglutide, semaglutide, and tirzepatide treatment.

    “Similar differences in effectiveness are found when looking at reductions in waist circumference, systolic blood pressure, and serum triglycerides, with differences in effect sizes reflecting the differences in weight loss in response to liraglutide, semaglutide, and tirzepatide treatment.15,70”

    From GLP-1 receptor agonists and next-generation incretin-based medications: metabolic, cardiovascular, and renal benefits (2026) · cites this paper as [70]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Semaglutide groups demonstrated a significant reduction in weight at the end of the treatment period for various steps: 14.9% for STEP 1, 16% for STEP 3, 17.4% for STEP 4, 15.2% for STEP 5, and 15.8% for STEP 8.

    “the semaglutide groups demonstrated a significant reduction in weight at the end of the treatment period for various steps, namely, 14.9% for STEP 1, 16% for STEP 3, 17.4% for STEP 4, 15.2% for STEP 5, and 15.8% for STEP 8.”

    From Efficacy and safety of semaglutide 2.4 mg for weight loss in overweight or obese adults without diabetes: An updated systematic review and meta‐analysis including the 2‐year <scp>STEP</scp> 5 trial (2024) · cites this paper as [20]

    The Primary Outcome section reports a 15.8% mean weight reduction with semaglutide at week 68 in STEP 8, significantly greater than with liraglutide. This paper reports the STEP 8 trial; the cited passages do not substantiate the four percentages attributed to STEP 1, STEP 3, STEP 4, and STEP 5. (LLM, conf=0.90)

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  • Long-term adherence to obesity medications in a real-world setting is challenging because the medications are expensive and gastrointestinal adverse events are common.

    “Despite the large weight losses with obesity medications, long-term adherence in a real-world setting is challenging since the medications are expensive and gastrointestinal adverse events are common.8,10,11”

    From Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial (2024) · cites this paper as [11]

    The Adverse Events section reports frequent gastrointestinal events with both medications and some gastrointestinal-related discontinuations. It does not establish that medication costs make long-term adherence difficult in real-world settings; those parts of the claim are unsupported by this trial. (LLM, conf=0.86)

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  • Semaglutide is superior to other GLP-1 receptor agonists for weight loss.

    “noted superiority over other GLP-1RAs.”

    From Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin – a case series (2023) · cites this paper as [30]

    The Primary Outcome section reports significantly greater weight loss with semaglutide than with liraglutide at 68 weeks in adults with overweight or obesity without diabetes. The study compared semaglutide with one other GLP-1 receptor agonist, liraglutide; it does not establish superiority over GLP-1 receptor agonists generally. (LLM, conf=0.87)

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Research works printed but not linked: 9

  1. [2]2. Wilding JPH, Batterham RL, Calanna S, et al; STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/ NEJMoa2032183
  2. [7]7. Knudsen LB, Lau J. The discovery and development of liraglutide and semaglutide. Front Endocrinol (Lausanne). 2019;10:155. doi:10.3389/ fendo.2019.00155
  3. [15]15. Little RJA, Rubin D B. Statistical Analysis With Missing Data. John Wiley & Sons; 1987.
  4. [24]24. Divino V, Ramasamy A, Anupindi VR, et al. Complication-specific direct medical costs by body mass index for 13 obesity-related complications: a retrospective database study. J Manag Care Spec Pharm. 2021;27(2):210-222. doi:10.18553/jmcp. 2020.20272 · DOI
  5. [25]25. Cawley J, Meyerhoefer C, Biener A, Hammer M, Wintfeld N. Savings in medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes status. Pharmacoeconomics. 2015;33(7):707-722. doi:10. 1007/s40273-014-0230-2
  6. [29]29. Davies MJ, Bergenstal R, Bode B, et al; NN8022-1922 Study Group. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE Diabetes randomized clinical trial. JAMA. 2015;314(7):687-699. doi:10.1001/ jama.2015.9676
  7. [30]30. Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016;40(8):1310-1319. doi:10.1038/ijo. 2016.52 · DOI
  8. [31]31. O'Neil PM, Aroda VR, Astrup A, et al; Satiety and Clinical Adiposity-Liraglutide Evidence in individuals with and without diabetes (SCALE) study groups. Neuropsychiatric safety with liraglutide 3.0 mg for weight management: results from randomized controlled phase 2 and 3a trials. Diabetes Obes Metab. 2017;19(11):1529-1536. doi:10. 1111/dom.12963
  9. [33]33. Hauber AB, Nguyen H, Posner J, Kalsekar I, Ruggles J. A discrete-choice experiment to quantify patient preferences for frequency of glucagon-like peptide-1 receptor agonist injections in the treatment of type 2 diabetes. Curr Med Res Opin. 2016;32(2):251-262. doi:10.1185/03007995.2015. 1117433 · DOI

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Authors
Rubino, D. M., Greenway, F. L., Khalid, U., O’Neil, P. M., Rosenstock, J., Sørrig, R., Wadden, T. A., Wizert, A., Garvey, W. T., STEP 8 Investigators, Arauz-Pacheco, C., Cannon, K., Downey, H. J., Fitz-Patrick, D., Geohas, J., Gerety, G., Gilbert, J., Hollander, P., Klein, E., Laufer, K., O'Donnell, P., Rosenblit, P., & Toth, P.
Affiliations
  • Washington Center for Weight Management and Research (US)
  • Pennington Biomedical Research Center (US)
  • Novo Nordisk (Denmark) (DK)
  • Medical University of South Carolina (US)
  • Dallas Diabetes Research Center (US)
  • University of Pennsylvania (US)
  • University of Alabama at Birmingham (US)
  • for the STEP 8 Investigators
Venue
JAMA
Published
2022-01-11
Volume
327
Issue
2
Pages
138
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
OpenAlex
W4205651374
Cited by
995
References
18
Citations by year
2026: 200 · 2025: 274 · 2024: 259 · 2023: 187 · 2022: 74 · 2014: 1
FWCI
118.78
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK056336)
Topics
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Keywords
semaglutide, liraglutide, GLP-1 receptor agonists, obesity, overweight, weight loss, weight-related comorbidities, adverse events, drug safety, dose escalation, placebo comparison, open-label extension, GLP-1 receptor antagonists, weight regain after weight loss
MeSH terms
Liraglutide, Semaglutide, Body Weight, Diabetes Mellitus, Diet Therapy, Drug Administration Schedule, Glucagon-Like Peptides, Female, Humans, Hypoglycemic Agents, Injections, Subcutaneous, Male, Middle Aged, Obesity, Patient Dropouts, Placebos, United States, Weight Loss, Exercise, Odds Ratio, Treatment Outcome, Overweight

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