Glucagon-like peptide-1 receptor agonist in large vessel occlusion treated by reperfusion therapy—a phase 2 randomized trial
Abstract
Abstract We aimed to determine the effect of semaglutide on patients with acute large vessel occlusion (LVO) receiving endovascular therapy (EVT). In this phase 2, investigator-initiated, multicenter, prospective, randomized, open-label, blinded endpoint trial conducted in China, we recruited patients with disabling LVO undergoing EVT. Patients were randomized to semaglutide therapy (0.5 mg subcutaneous semaglutide before and 1 week after EVT) or standard therapy. The primary outcome was defined as favorable neurological recovery (modified Rankin Scale 0–2 at 90 days). Between August 2023 and July 2024, 140 patients were randomized to semaglutide ( n = 69) or standard therapy ( n = 71). The primary outcome occurred in 39 (56.5%) in the semaglutide group and 39 (54.9%) in the standard therapy group (adjusted RR 1.05, 95% CI 0.95–1.15, p = 0.37). We observed treatment effect modification by intravenous thrombolysis (IVT) on semaglutide therapy ( p interaction = 0.02); thus we performed the following exploratory analyses: The primary outcome occurred in 22 (64.7%) in the semaglutide group and 15 (44.1%) in the standard therapy group (adjusted RR 1.18, 95% CI 1.02–1.36) in the no-IVT stratum ( n = 68). The primary outcome was similar between two groups in the IVT-stratum. No severe adverse event was attributed to semaglutide treatment. This phase 2 trial suggested semaglutide was safe in patients with LVO and was associated with an improved neurological outcome in patients not receiving IVT. These preliminary observations should be confirmed in a phase 3 randomized trial (ClinicalTrials.gov Identifier: NCT05920889).
Article Details
Authors (46)
Hao Wang
Division of Quantitative Sciences, Department of Oncology Johns Hopkins University School of Medicine Baltimore Maryland USA
Ho Ko
Thomas W. Leung
Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Junzhe Huang
Junjie Sai
Yu Liang
The Sixth Laboratory
Haipeng Li
Jie Zhang
Qingyang Cao
Wentao Zang
Yinfei Li
Sze Ho Ma
Wai Ting Lui
Joseph Choi
Charlie Chan
Jason Wong
Andrew J. Kwok
Karen Ma
Florence Fan
Anne Chan
Vincent Ip
Howan Leung
Yannie Soo
Ka Tak Wong
Billy Lai
CM Chu
Ho Sang Leung
Anselm Hui
Tom Cheung
Jill Abrigo
Siu Hung Li
Larry Chan
Jonas Yeung
Sangqi Pan
Terry Yip
LT Lui
Trista Hung
Suk Fung Tsang
Xinyi Leng
Bonnie Lam
Vincent C. T. Mok
Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
Rosa H. M. Chan
Thanh N. Nguyen
Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston
Wei Hu
Fengyuan Che
Bonaventure Y. Ip