Comparison of cardiovascular outcomes between once‐weekly semaglutide and dulaglutide in adults with type 2 diabetes and established atherosclerotic cardiovascular disease in the United States

AIMS: This study aims to compare the risk of major adverse cardiovascular events (MACE) among United States individuals with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) treated with once-weekly semaglutide vs. dulaglutide. MATERIALS AND METHODS: This was a retrospective cohort study using Optum's de-identified Clinformatics Data Mart (Optum CDM) from 1 January 2007 through 30 September 2024. New initiators of semaglutide or dulaglutide ≥18 years with both T2D and ASCVD were included. The index date was the first date of a prescription claim for semaglutide or dulaglutide within the index medication identification period (1 January 2018 through 31 March 2024). The primary outcome was 3-point MACE (stroke, myocardial infarction [MI], cardiovascular [CV]-related death). Entropy balancing was applied to balance baseline characteristics. Weighted incidence rates per 1000 person-years and doubly robust Cox proportional hazard ratios were reported. RESULTS: There were 75 243 enrolees included (semaglutide, 42 007; dulaglutide, 33 236). The mean age was 68.2 and 69.3 years (unweighted) in the semaglutide and dulaglutide cohorts, respectively. After balancing, standardized mean differences were