Liraglutide vs Semaglutide vs Dulaglutide in Veterans With Type 2 Diabetes
Authors' conclusion
In this comparative effectiveness study in veterans with diabetes, liraglutide, semaglutide, and dulaglutide initiators had similar risks for kidney and cardiovascular outcomes. Head-to-head randomized trials are needed to confirm these findings.
Study context
- Population
- GLP-1RA-naive veterans with T2D, without end-stage kidney disease, treated with metformin, starting liraglutide, semaglutide or dulaglutide 2018–2021; Veterans Affairs (VA), Medicare and US Renal Data System data
- Participants
- 21,790 veterans
- Comparison
- Liraglutide vs semaglutide vs dulaglutide
- Liraglutiden = 5,425
- Semaglutiden = 10,838reference
- Dulaglutiden = 5,527
- Outcome
- Kidney failure (sustained eGFR <15 mL/min/1.73 m² or kidney replacement therapy), composite cardiovascular and kidney metabolic (CKM) events (kidney failure or MACE), MACE, all-cause death and GI adverse events, evaluated separately
- Follow-up
- Through March 31, 2023
Methodological detailstarget trial emulation, active-comparator, new-user, target trial-emulation design, weighted Cox regression
- Target trial emulation
- Active-comparator
- New-user
- Target trial-emulation design
- Weighted Cox regression
Main finding
As reported in the abstract
Kidney failure, CKM composite and MACE
Liraglutide vs SemaglutideHazard ratio (95% CI)
Kidney failure
0.93(0.60–1.44)
CKM composite
0.96(0.84–1.10)
MACE
0.95(0.83–1.09)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause deathLiraglutidevs SemaglutideIntent-to-treat; lost significance in per-protocol models | 0.83 (0.69–0.99) | |
| All-cause deathLiraglutidevs DulaglutideIntent-to-treat | 0.69 (0.58–0.83) | |
| All-cause deathLiraglutidevs DulaglutidePer-protocol | 0.50 (0.31–0.82) | |
| All-cause deathDulaglutidevs SemaglutidePer-protocol only | 1.72 (1.20–2.47) | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| GI adverse eventsDulaglutidevs SemaglutideGallstones · only observed GI difference | 0.72 (0.54–0.95) | |
| GI adverse eventsDulaglutidevs SemaglutideAcute cholecystitis · only observed GI difference | 0.62 (0.39–0.99) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Liraglutide vs Semaglutide vs Dulaglutide in Veterans With Type 2 Diabetes. JAMA Netw Open. Published 1 October 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →