Differences in weight loss and safety between the glucagon-like peptide-1 receptor agonists: A non-randomized multicenter study from the titration phase.

INTRODUCTION: Obesity increases the risk of type 2 diabetes mellitus and cardiovascular disease (CVD). Weight loss (≥5 %) reduces the risk of CVD. Glucagon-like peptide-1 receptor agonists (GLP1 RA) have shown clinically weight loss. OBJECTIVES: 1) To assess differences in the efficacy of weight loss and HbA1c; 2) to evaluate the safety and adherence during the titration phase. METHODS: It is a multicenter, prospective, and observational study on GLP1 RA naïve patients. The primary end point was the weight loss (≥5 %). Changes in weight, BMI and HbA1c were also calculated as co-primary endpoints. Secondary endpoints were safety, adherence, and tolerance. RESULTS: Among 94 subjects, 42.4 % received dulaglutide, 29,3 % subcutaneous semaglutide, 22,8 % oral semaglutide. 45 % female and the mean age was 62. Baseline characteristics were body weight 99.3 kg, BMI 36.7 kg/m2 and Hba1c 8.2 %. Oral semaglutide achieved the highest reduction: 61.1 % of patients achieving ≥ 5 %, subcutaneous semaglutide 45.8 % and dulaglutide 40.6 %. GLP1 RA significantly reduced body weight (-4.95 kg, p < 0.001) and BMI (-1.86 kg/m2, p < 0.001), without significant differences between groups. Gastrointestinal disorders were the most frequently reported events (74.5 %). 62 % of patients on dulaglutide, 25 % on oral semaglutide and 22 % on subcutaneous semaglutide. CONCLUSIONS: Oral semaglutide achieved the highest proportion of patients that lost ≥ 5 %. GLP1 RA significantly reduced BMI and HbA1c. Most of the reported adverse events were gastrointestinal disorders and they were reported in a major frequency in the dulaglutide group. Oral semaglutide would be a reasonable switch in case of future shortages.

Semaglutide versus GLP-1 agonists. Effectiveness, safety, and quality of life in patients with diabetes mellitus 2. The SEVERAL study.

OBJECTIVE: The cardiovascular disease is the first cause of deaths in patients  with diabetes mellitus 2. The objective is to evaluate and compare the weight  loss in patients with diabetes treated with the different GLP-1 receptor agonists  for the first time. Secondary endpoints are glycosylated hemoglobin  reduction, changes in quality of life and physical activity and the safety of  these drugs. METHOD: It is a postauthorization, multicenter, non-randomized and  prospective study. 360 Patients that will start treatment for the first time with GLP-1 receptor agonists will be recruited in 10 centers in the National Health System for a period of 6 months and 44 weeks of follow-up.  The primary endpoint will be weight loss achieved with the different GLP-1  receptor agonists and the secondary endpoint will be glycosylated hemoglobin reduction, changes in the quality of life through the EuroQol­5D and changes physical activity through the SF-12 questionnaire, and also the  safety of these drugs. The estimate recruitment period will be 6 months, from  1 December 2021 to 1 May 2022. The follow up will finish in December 2022. DISCUSSION: The SEVERAL study will try to provide information about weight  loss efficacy, changes in quality of life, physical activity and safety of the GLP-1  receptor agonists in patients with diabetes that start treatment with these  drugs in the real life. This study try to compare different GLP-1 receptor  gonists in terms of effectiveness and safety for a better posterior election when  these drugs are used in patients with diabetes mellitus 2 and obesity.

OBJETIVO: La enfermedad cardiovascular es la causa principal de muerte en  pacientes con diabetes mellitus 2. El objetivo principal es evaluar y comparar  prospectivamente la pérdida de peso en pacientes con diabetes mellitus 2  tratados por primera vez con los diferentes análogos de la GLP-1. Como  variables secundarias se estudiará reducción de la hemoglobina glicosilada,  cambios en calidad de vida y actividad física y la seguridad de estos fármacos.Método: Se trata de un estudio postautorización, multicéntrico, no  leatorizado de seguimiento prospectivo. Se reclutarán 360 pacientes que inicien tratamiento por primera vez con análogos de la GLP1 en 10 centros del sistema público durante un período de 6 meses y un seguimiento  de 44 semanas. La variable principal será la pérdida de peso con los  diferentes análogos de la GLP1 y como variable secundaria se valorarán: reducción de hemoglobina glicosilada, cambios en la calidad de vida y actividad  física a través del EuroQol-5D y SF-12 y seguridad. Se ha estimadoun período de reclutamiento de 6 meses, desde el 1 de Diciembre 2021 al 1 de Mayo 2022. El seguimiento finalizará en Diciembre de 2022.Discusión: El estudio intentará aportar información sobre la efectividad en  pérdida de peso, cambios en calidad de vida, actividad física y seguridad de los  análogos de la GLP1 en pacientes con diabetes mellitus 2 que inician  tratamiento con estos fármacos en la vida real. Este trabajo pretende comparar  los diferentes análogos de la GLP1 en términos de eficacia y  eguridad para una posterior mejor elección en la prescripción de estos  fármacos en pacientes con diabetes mellitus 2 y obesidad.

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study.

The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64-81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.

A Case Study on Polypharmacy and Depression in a 75-Year-Old Woman with Visual Deficits and Charles Bonnet Syndrome.

Depression is one of the most prevalent pathologies in older adults. Its diagnosis and treatment are complex due to different factors that intervene in its development and progression, including intercurrent organic diseases, perceptual deficits, use of drugs, and psycho-social conditions associated with the aging process. We present the case of a 75-year-old woman (who lives in the community) with a diagnosis of major depression with more than 10 years of history, analyzing her evolution and therapeutic approach.