Real-World Use of Oral Semaglutide in Adults with Type 2 Diabetes: The PIONEER REAL Switzerland Multicentre, Prospective, Observational Study

Introduction: Real-world data provide insight into how medications perform in clinical practice. The PIONEER REAL Switzerland study aimed to understand clinical outcomes with oral semaglutide in adults with type 2 diabetes (T2D). Methods: PIONEER REAL Switzerland was a 34–44-week, multicentre, prospective, non-interventional, single-arm study of adults with T2D naïve to injectable glucose-lowering medication who were initiated on oral semaglutide in routine clinical practice. The primary endpoint was change in glycated haemoglobin (HbA) from baseline (BL) to end of study (EOS); secondary endpoints included change in body weight (BW) from BL to EOS and the proportion of participants achieving HbA < 7.0% and the composite endpoints HbA reduction ≥ 1%-points with BW reduction ≥ 3% or ≥ 5% at EOS. Safety was assessed in participants who received ≥ 1 dose of oral semaglutide. Results: Of the 185 participants (female/male, n = 67/118) initiating oral semaglutide, 168 (90.8%) completed the study and 143 (77.3%) remained on treatment with oral semaglutide at EOS. At BL, participants had a mean age of 62 years, diabetes duration of 6.4 years, HbA of 7.7%, BW of 95.6 kg and body mass index of 33.2 kg/m; 56.2% of participants were receiving glucose-lowering medications. Significant reductions were observed for HbA (estimated change − 0.91%; 95% confidence interval [CI] − 1.10, − 0.71; p < 0.0001) and BW (estimated change − 4.85%; 95% CI − 5.70, − 4.00; p < 0.0001). In total, 139 adverse events (AEs) were reported in 65 (35.1%) participants; most were mild or moderate. The most frequent AEs were gastrointestinal disorders (27.0%); 31 AEs in 20 (10.8%) participants led to discontinuation of oral semaglutide. Six serious AEs were reported; all were considered unlikely to be related to oral semaglutide. Conclusion: People living with T2D treated with oral semaglutide in Switzerland achieved clinically significant reductions in HbA and BW, with no new safety signals. Clinical Trial Registration: ClinicalTrials.gov: NCT04537624. A graphical abstract is available for this article. Graphical abstract: (Figure presented.).