What is the maintenance dose of semaglutide (Glucagon-like peptide-1 (GLP-1) receptor agonist)?

From the Guidelines

The maintenance dose of semaglutide for type 2 diabetes is 1 mg administered once weekly via subcutaneous injection, as recommended by the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1.

Key Points to Consider

• The dose escalation schedule is crucial to minimize gastrointestinal side effects, starting with 0.25 mg weekly for 4 weeks, then increasing to 0.5 mg weekly for 4 weeks, before reaching the maintenance dose 1.
• Semaglutide works by mimicking GLP-1, which increases insulin secretion, decreases glucagon secretion, slows gastric emptying, and reduces appetite.
• The medication has been shown to reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease, as demonstrated in the SUSTAIN-6 trial 1.

Important Considerations for Dosing

• The dose should be titrated slowly to reduce nausea and vomiting, and discontinued if pancreatitis is suspected 1.
• Patients with an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m² should not use semaglutide, and those with an eGFR between 15 and 29 mL/min/1.73 m² should use caution and monitor renal function 1.
• Semaglutide is contraindicated in patients with a history of serious hypersensitivity reaction to the drug, pregnancy or breastfeeding, severe renal impairment or end-stage renal failure, personal or family history of medullary thyroid cancer, or personal or family history of multiple endocrine neoplasia type 2 (MEN2) 1.

From the Research

Maintenance Dose of Semaglutide

• The maintenance dose of semaglutide is typically 0.5 mg or 1.0 mg administered subcutaneously once weekly 2.
• A population pharmacokinetic study found that semaglutide exposure is stable over time and is not affected by covariates such as sex, age, race, ethnicity, renal function, or injection site used, except for body weight 2.
• Dose proportionality was shown for the 0.5 mg and 1.0 mg maintenance doses of semaglutide, indicating that the drug's efficacy and safety are consistent across these doses 2.

Efficacy and Safety of Semaglutide

• A double-blind, randomized, phase 3B trial (SUSTAIN FORTE) compared the efficacy and safety of once-weekly semaglutide 2.0 mg versus 1.0 mg in patients with type 2 diabetes and found that the 2.0 mg dose was superior in reducing HbA1c and body weight, with a similar safety profile 3.
• Semaglutide has been shown to have cardiovascular benefits, reducing the risk of major adverse cardiovascular events in patients with established cardiovascular disease 4, 5.
• The drug is generally well-tolerated, with gastrointestinal disorders being the most commonly reported adverse events 3.

Clinical Use of Semaglutide

• Semaglutide is approved as a second-line treatment option for type 2 diabetes, and its use has been supported in patients with cardiovascular disease or risk factors 4, 5.
• The drug's pharmacokinetics make it ideal for once-weekly dosing, and its efficacy and safety have been established in clinical trials 2, 3.
• Semaglutide may be a useful treatment option for patients with type 2 diabetes who require additional glycemic control, particularly those with cardiovascular disease or risk factors 3, 4, 5.