“Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes: Target Trial Emulation Using Real-World Data”, 2024-07-30 (; similar):
Background: Reports of reduced desire to smoke in patients treated with semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA) medication for type 2 diabetes mellitus (T2DM) and obesity, have raised interest about its potential benefit for tobacco use disorders (TUDs).
Objective: To examine the association of semaglutide with TUD-related health care measures in patients with comorbid T2DM and TUD.
Design: Emulation target trial based on a nationwide population-based database of patient electronic health records.
Setting: United States, 2017–12-01–2023-03-31.
Participants: 7 target trials were emulated among eligible patients with comorbid T2DM and TUD by comparing the new use of semaglutide versus 7 other anti-diabetes medications (insulins, metformin, dipeptidyl-peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, and other GLP-1RAs).
Measurements: The TUD-related health care measures (medical encounter for diagnosis of TUD, smoking cessation medication prescriptions, and smoking cessation counseling) that occurred within a 12-month follow-up were examined using Cox proportional hazards and Kaplan-Meier survival analyses.
Results: The study compared 222,942 new users of anti-diabetes medications including 5,967 of semaglutide.
Semaglutide was associated with a statistically-significantly lower risk for medical encounters for TUD diagnosis compared with other anti-diabetes medications, and was strongest compared with insulins (hazard ratio [HR], 0.68 [95% CI, 0.63–0.74]) and weakest but statistically-significant compared with other GLP-1RAs (HR, 0.88 [CI, 0.81–0.96]). Semaglutide was associated with reduced smoking cessation medication prescriptions and counseling.
Similar findings were observed in patients with and without a diagnosis of obesity.
For most of the group comparisons, the differences occurred within 30 days of prescription initiation.
Limitations: Documentation bias, residual confounding, missing data on current smoking behavior, body mass index, and medication adherence.
Conclusion: Semaglutide was associated with lower risks for TUD-related health care measures in patients with comorbid T2DM and TUD compared with other anti-diabetes medications including other GLP-1Ras, primarily within 30 days of prescription. These findings suggest the need for clinical trials to evaluate semaglutide’s potential for TUD treatment.
Primary Funding Source: National Institutes of Health.