The FDA approved semaglutide (Ozempic; Novo Nordisk) to reduce the risk of worsening kidney disease, kidney failure, and death due to cardiovascular disease in adult patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), according to a news release from Novo Nordisk.1
"Chronic kidney disease is very serious and common in patients living with type 2 diabetes and represents a critical need for adults living with these comorbidities,” Anna Windle, PhD, senior vice president of clinical development at Novo Nordisk, said in the news release. “This approval for [semaglutide] allows us to more broadly address conditions within cardiovascular-kidney-metabolic syndrome, which affects millions of adults and could have serious consequences if left untreated.”1
The approval adds to semaglutide’s approved indications, including improving glycemic control for adults with T2D and reducing the risk of major cardiovascular events in adults with known heart disease.2,3,4
Results from the randomized, double-blind, placebo-controlled phase 3b FLOW trial (NCT03819153) provided the basis for the FDA’s regulatory decision, which were presented by investigators at the 84th Annual Scientific Sessions of the American Diabetes Association. The trial was stopped early upon the recommendation of an independent monitoring committee due to the pre-specified efficacy end point being met after a median 3.4 years of follow-up.1,5
About the Trial
Trial Name: A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease (FLOW)
ClinicalTrials.gov ID: NCT03819153
Sponsor: Novo Nordisk A/S
Completion Date: January 9, 2024
In the trial, which enrolled a total of 3533 patients with T2D or CKD, once weekly semaglutide 1 mg led to a 24% reduction in the risk of kidney disease progression and kidney and cardiovascular mortality compared with placebo (331 vs 410 events; HR: 0.76 [0.66, 0.88]; P = .0003).5
Data also indicated that semaglutide 1 mg demonstrated superiority to placebo for all secondary outcomes, including inducing a significant reduction in mean annual glomerular filtration rate slope and a significant reduction in the risk of major cardiovascular events in patients treated with the GLP-1 receptor agonist (RA). Patients treated with semaglutide experienced 212 cardiovascular events, compared with 254 events for the placebo group; furthermore, there was a meaningfully lower risk of death in the semaglutide group compared with the placebo group.5
"A large portion of patients I treat experience serious kidney complications and comorbidities, with some even requiring dialysis,” Richard E Pratley, MD, co-chair of the FLOW trial, said in the news release. “Today's decision by the FDA offers hope for the millions of adults living with both conditions and provides an additional treatment option, representing a significant advancement for my patients."1
Pharmacists have an outsized role in guiding patients with T2D or CKD regarding treatment with GLP-1 RAs. These medications have the potential to provide life-changing impacts for patients struggling with worsening kidney disease or those concerned about their increased cardiovascular disease risk. For patients to safely use these medications, pharmacists are essential, as they can educate patients on whether a GLP-1 RA is the right treatment for them while ensuring the correct dosing and administration of the medication.
REFERENCES
1. Novo Nordisk. FDA approves Ozempic (semaglutide) as the only GLP-1 RA to reduce the risk of worsening kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease. News Release. Released January 28, 2025. Accessed January 28, 2025. https://www.prnewswire.com/news-releases/fda-approves-ozempic-semaglutide-as-the-only-glp-1-ra-to-reduce-the-risk-of-worsening-kidney-disease-and-cardiovascular-death-in-adults-with-type-2-diabetes-and-chronic-kidney-disease-302362466.html
2. Gerlach A. GLP-1 receptor agonists show promise in treating obesity-related heart failure. Pharmacy Times. Published November 14, 2024. Accessed January 28, 2025. https://www.pharmacytimes.com/view/glp-1-receptor-agonists-show-promise-in-treating-obesity-related-heart-failure
3. Gallagher A. FDA approves semaglutide for new indication involving cardiovascular disease. Pharmacy Times. Published March 8, 2024. Accessed January 28, 2025. https://www.pharmacytimes.com/view/fda-approves-semaglutide-for-new-indication-involving-cardiovascular-disease
4. Antrim A. FDA approves label update for semaglutide, allowing use as first-line option for adults with type 2 diabetes. Pharmacy Times. Published January 16, 2023. Accessed January 28, 2025. https://www.pharmacytimes.com/view/fda-approves-label-update-for-semaglutide-allowing-use-as-first-line-option-for-adults-with-type-2-diabetes
5. Novo Nordisk. Ozempic (semaglutide) injection 1 mg demonstrated reduction in risk of kidney disease-related events in Phase 3 FLOW trial presented at the 84th Scientific Sessions of the American Diabetes Association. News Release. Released June 24, 2024. Accessed January 28, 2025. https://www.prnewswire.com/news-releases/ozempic-semaglutide-injection-1-mg-demonstrated-reduction-in-risk-of-kidney-disease-related-events-in-phase-3-flow-trial-presented-at-the-84th-scientific-sessions-of-the-american-diabetes-association-302180599.html
6. ClinicalTrials.gov. A research study to see how semaglutide works compared to placebo in people with type 2 diabetes and chronic kidney disease (FLOW). National Library of Medicine. Last Updated August 2, 2024. Accessed January 28, 2025. https://clinicaltrials.gov/study/NCT03819153