Target Trial of Semaglutide Versus Dulaglutide or Liraglutide in Patients Receiving Hemodialysis.
Publication/Presentation Date
10-27-2026
Abstract
OBJECTIVE: To evaluate the comparative effectiveness of semaglutide versus dulaglutide or liraglutide in patients with diabetes receiving maintenance hemodialysis.
RESEARCH DESIGN AND METHODS: Using 2011-2022 U.S. Renal Data System and Medicare data, we emulated a target trial evaluating semaglutide versus dulaglutide or liraglutide in patients receiving hemodialysis. Overlap weights were used to adjust for confounders. Fine-Gray models were used to assess death on dialysis and hospitalization. A generalized estimating equation was used for repeated measures of body weight.
RESULTS: We identified 1,312 semaglutide and 2,601 dulaglutide or liraglutide users. After overlap weighting, the effective sample size was 3,200 patients (mean age 61; 63% White; 28% Black; 52% male; median [interquartile range] BMI 34 [29-40] kg/m2; median follow-up 1.1 [0.6-1.9] years). Semaglutide versus dulaglutide or liraglutide was associated with a mortality on dialysis subdistribution hazard ratio (sHR) of 0.82 (95% CI 0.70-0.97; 1-year cumulative incidence 11% vs. 13%) and all-cause hospitalization sHR of 0.91 (95% CI 0.83-0.99; 1-year incidence 57% vs. 62%). Body weight loss was higher with semaglutide (-4.8%, 95% CI -5.3% to -4.2%) at 1 year vs. -3.4%, 95% CI -3.9% to -3.1%). Direct comparisons of semaglutide versus dulaglutide showed similar results for mortality (sHR 0.82, 95% CI 0.69-0.97) and hospitalization (sHR 0.88, 95% CI 0.81-0.97), but semaglutide versus liraglutide showed no statistically significant benefit for mortality or hospitalization.
CONCLUSIONS: Among patients with diabetes receiving hemodialysis and equipoise between semaglutide and dulaglutide or liraglutide, semaglutide may be the preferred glucagon-like peptide 1 agent compared with dulaglutide.
ISSN
1935-5548
Published In/Presented At
Le, D., Forman, E., Kraft, W. K., Grams, M. E., Jaar, B. G., & Shin, J. I. (2026). Target Trial of Semaglutide Versus Dulaglutide or Liraglutide in Patients Receiving Hemodialysis. Diabetes care, dc262069. Advance online publication. https://doi.org/10.2337/dc26-2069
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42937520
Department(s)
Administration and Leadership
Document Type
Article