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Trial · Interventional

CompletedPhase 3Results postedRegistry data

Efficacy and Safety of Oral Semaglutide Versus Placebo in Subjects With Type 2 Diabetes and Moderate Renal Impairment

Short name PIONEER 5

NCTNCT02827708 (opens ClinicalTrials.gov in a new tab)Other idNN9924-4234Other id2015-005326-19Other idU1111-1176-9230Other id2015

Overview

Status
Completed
Phase
Phase 3
Enrollment
324 participants (actual)
Sponsor
Novo Nordisk A/S · Industry
Design
Randomized · Double masking
Countries
8 countries

United States, Denmark, Finland, Israel, Poland, Russia, Sweden, United Kingdom

Start
20 Sept 2016
Primary completion
10 Apr 2018
Completion
15 May 2018
First posted
11 Jul 2016 (estimated)
Last update posted
17 Feb 2020
Conditions
Diabetes · Diabetes Mellitus, Type 2

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
2016201720182019
  1. Ph 3

    PIONEER 5

    NCT02827708

    20 Sept 2016 to 15 May 2018

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This trial is conducted globally. The aim of this trial is to investigate efficacy and safety of oral semaglutide versus placebo in subjects with type 2 diabetes and moderate renal impairment.

Interventions

  • semaglutideDrug
  • placeboDrug

Arms2

  • Experimental

    Semaglutide

  • Placebo comparator

    Placebo

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Change in HbA1c

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in glycosylated haemoglobin (HbA1c) was evaluated at week 26. The endpoint was evaluated based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product. The endpoint was also evaluated based on the data from the on-treatment without rescue medication observation period, which was the time period when a participant was on treatment with trial product, excluding any period after initiation of rescue medication and/or premature trial product discontinuation.

Secondary outcomes(20)
  1. Change in Body Weight (kg)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in body weight was evaluated at week 26. The endpoint was evaluated based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product. The endpoint was also evaluated based on the data from the on-treatment without rescue medication observation period, which was the time period when a participant was on treatment with trial product, excluding any period after initiation of rescue medication and/or premature trial product discontinuation.

  2. Change in FPG

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in fasting plasma glucose (FPG) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  3. Change in Body Weight (%)

    Time frame · Week 0, week 26

    Registry description

    Relative change from baseline (week 0) in body weight (kg) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  4. Change in BMI

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in body mass index (BMI) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  5. Change in Waist Circumference

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in waist circumference was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  6. Participants Who Achieve HbA1c <7.0% (53 mmol/Mol), ADA Target (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved HbA1c \<7.0% (American Diabetes Association (ADA) target) (yes/no), was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  7. Participants Who Achieve HbA1c ≤6.5% (48 mmol/Mol), AACE Target (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved HbA1c ≤6.5% (American Association of Clinical Endocrinologists (AACE) target) (yes/no), was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  8. Participants Who Achieve Weight Loss ≥5% (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved weight loss ≥5% of their baseline body weight (yes/no) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  9. Participants Who Achieve Weight Loss ≥10% (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved weight loss of ≥10% of their baseline body weight (yes/no) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  10. Participants Who Achieve HbA1c <7.0 % (53 mmol/Mol) Without Hypoglycaemia (Severe or BG Confirmed Symptomatic Hypoglycaemia) and no Weight Gain (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved HbA1c \<7.0 % without severe or blood glucose (BG) confirmed symptomatic hypoglycaemia and without weight gain (yes/no) was evaluated at week 26. Severe hypoglycaemia was defined as an episode requiring assistance of another person to actively administer carbohydrate or glucagon, or take other corrective actions. BG-confirmed symptomatic hypoglycaemia was defined as an episode with plasma glucose value \<3.1 mmol/L with symptoms consistent with hypoglycaemia. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  11. Participants Who Achieve HbA1c Reduction ≥1% (10.9 mmol/Mol) and Weight Loss ≥3% (Yes/no)

    Time frame · Week 26

    Registry description

    Participants who achieved HbA1c reduction ≥1% and weight loss of ≥3% (yes/no) was evaluated at week 26. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  12. Change in Total Cholesterol (Ratio to Baseline)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in total cholesterol (mmol/L) at week 26 is presented as ratio to baseline. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  13. Change in LDL Cholesterol (Ratio to Baseline)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in low-density lipoprotein (LDL) cholesterol (mmol/L) at week 26 is presented as ratio to baseline. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  14. Change in HDL Cholesterol (Ratio to Baseline)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in high-density lipoprotein (HDL) cholesterol (mmol/L) at week 26 is presented as ratio to baseline. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  15. Change in Triglycerides (Ratio to Baseline)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in triglycerides (mmol/L) at week 26 is presented as ratio to baseline. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  16. Change in CRP (Ratio to Baseline)

    Time frame · Week 0, week 26

    Registry description

    Change from baseline (week 0) in C-reactive protein (CRP) (mg/L) at week 26 is presented as ratio to baseline. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  17. Time to Additional Anti-diabetic Medication

    Time frame · Weeks 0-26

    Registry description

    Presented results are the number of participants who had taken additional anti-diabetic medication anytime during the period, from week 0 to week 26. Additional anti-diabetic medication was defined as any new anti-diabetic medication used for more than 21 days with the initiation at or after randomisation (week 0) and before (planned) end-of-treatment (week 26), and/or intensification of anti-diabetic medication (a more than 20% increase in dose relative to baseline) for more than 21 days with the intensification at or after randomisation and before (planned) end-of-treatment. Results are based on the data from the in-trial observation period, which was the time period from when a participant was randomised until the final scheduled visit, including any period after initiation of rescue medication and/or premature discontinuation of trial product.

  18. Time to Rescue Medication

    Time frame · Weeks 0-26

    Registry description

    Presented results are the number of participants who had taken rescue medication anytime during the period, from week 0 to week 26. Rescue medication was defined as any new anti-diabetic medication used as add-on to trial product and used for more than 21 days with the initiation at or after randomisation (week 0) and before last day on trial product, and/or intensification of anti-diabetic medication (a more than 20% increase in dose relative to baseline) for more than 21 days with the intensification at or after randomisation and before last day on trial product. Results are based on the data from the on-treatment without rescue medication observation period, which was the time period when a participant was on treatment with trial product, excluding any period after initiation of rescue medication and/or premature trial product discontinuation.

  19. Number of TEAEs

    Time frame · Weeks 0-31

    Registry description

    Treatment emergent adverse events (TEAEs) were recorded from week 0 to week 31 (26 weeks treatment period + 5 weeks follow-up period). Adverse events (AEs) with onset during the on-treatment observation period were considered treatment-emergent. On-treatment observation period was defined as the time period when a participant was on treatment with trial product, including any period after initiation of rescue medication.

  20. Number of Treatment-emergent Severe or BG-confirmed Symptomatic Hypoglycaemic Episodes

    Time frame · Weeks 0-31

    Registry description

    Treatment emergent severe or BG-confirmed symptomatic hypoglycaemic episodes were recorded from week 0 to week 31 (26 weeks treatment period + 5 weeks follow-up period). Hypoglycaemic episodes with onset during the first dose of trial product until last dose of trial product were considered treatment -emergent. Severe or BG-confirmed symptomatic hypoglycaemia was defined as an episode, that is severe according to the ADA classification or BG-confirmed by a plasma glucose value \<3.1 mmol/L with symptoms consistent with hypoglycaemia. Results are based on the data from the on-treatment observation period which was the time period when a participant was on treatment with trial product, including any period after initiation of rescue medication.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeMean· Week 0, week 26

Change in HbA1c

GroupValue (Percentage of HbA1c)Spread
Oral Semaglutide 14 mg-1.11.0
Placebo-0.20.9
Secondary and other outcome results(7)
Secondary outcomeMean· Week 0, week 26

Change in Body Weight (kg)

GroupValue (kg)Spread
Oral Semaglutide 14 mg-3.53.8
Placebo-0.92.9
Secondary outcomeMean· Week 0, week 26

Change in FPG

GroupValue (mmol/L)Spread
Oral Semaglutide 14 mg-1.582.96
Placebo-0.343.03
Secondary outcomeMean· Week 0, week 26

Change in Body Weight (%)

GroupValue (Percentage change)Spread
Oral Semaglutide 14 mg-3.754.10
Placebo-0.923.13
Secondary outcomeMean· Week 0, week 26

Change in BMI

GroupValue (kg/m^2)Spread
Oral Semaglutide 14 mg-1.21.3
Placebo-0.31.0
Secondary outcomeMean· Week 0, week 26

Change in Waist Circumference

GroupValue (Centimetre (cm))Spread
Oral Semaglutide 14 mg-2.84.9
Placebo-0.73.8
Secondary outcomeCount of participants· Week 26

Participants Who Achieve HbA1c <7.0% (53 mmol/Mol), ADA Target (Yes/no)

GroupValue (Participants)
Oral Semaglutide 14 mg89
Placebo35
Secondary outcomeCount of participants· Week 26

Participants Who Achieve HbA1c ≤6.5% (48 mmol/Mol), AACE Target (Yes/no)

GroupValue (Participants)
Oral Semaglutide 14 mg60
Placebo12

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
Oral Semaglutide 14 mgParticipants were to take oral semaglutide tablets once daily in a dose escalation manner from week 0 to week 26: 3 mg from week 0 to week 4, 7 mg from week 4 to week 8 and 14 mg from week 8 to week 26.1 / 16317 / 16375 / 163
PlaceboParticipants were to take oral semaglutide placebo tablets once daily from week 0 to week 26.2 / 16117 / 16132 / 161

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies7

Studies that cite this trial.

Studies with results

1 study on this page

Indexing hint: Meta-analysis (pooled) · 2025

15 results

Glucagon-like peptide 1 (GLP-1) receptor agonists for people with chronic kidney disease and diabetes.

Natale et al. 2025The Cochrane database of systematic reviewscited by 8

PMID 39963952PMC11834151DOI 10.1002/14651858.cd015849.pub2PUB-39963952

Rights unknown15 results

More studies

6 studies on this page

PubMed tag: none · 2022

Impact of semaglutide on high-sensitivity C-reactive protein: exploratory patient-level analyses of SUSTAIN and PIONEER randomized clinical trials.

Mosenzon et al. 2022Cardiovascular diabetologycited by 65

PMID 36056351PMC9440529DOI 10.1186/s12933-022-01585-7PUB-36056351

CC BY
Download PDF

PubMed tag: none · 2021

Oral Semaglutide Reduces HbA1c and Body Weight in Patients with Type 2 Diabetes Regardless of Background Glucose-Lowering Medication: PIONEER Subgroup Analyses.

Pratley et al. 2021Diabetes therapy : research, treatment and education of diabetes and related disorderscited by 10

PMID 33660198PMC7994454DOI 10.1007/s13300-020-00994-9PUB-33660198

Free to read · publisher termsCC BY-NC
Read at source

PubMed tag: none · 2020

Semaglutide (SUSTAIN and PIONEER) reduces cardiovascular events in type 2 diabetes across varying cardiovascular risk.

Husain et al. 2020Diabetes, obesity & metabolismcited by 154

PMID 31903692PMC7064975DOI 10.1111/dom.13955PUB-31903692

Free to read · publisher termsCC BY-NC
Read at source

Indexing hint: Review · 2020

Efficacy, safety and cardiovascular outcomes of once-daily oral semaglutide in patients with type 2 diabetes: The PIONEER programme.

Thethi et al. 2020Diabetes, obesity & metabolismcited by 98

PMID 32267058PMC7384149DOI 10.1111/dom.14054PUB-32267058

Free to read · publisher termsCC BY-NC
Read at source

PubMed tag: none · 2020

Effects of semaglutide on risk of cardiovascular events across a continuum of cardiovascular risk: combined post hoc analysis of the SUSTAIN and PIONEER trials.

Husain et al. 2020Cardiovascular diabetologycited by 33

PMID 32998732PMC7526237DOI 10.1186/s12933-020-01106-4PUB-32998732

CC BY
Download PDF

Indexing hint: Randomized controlled trial · 2019

Corrected

Efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment (PIONEER 5): a placebo-controlled, randomised, phase 3a trial.

Mosenzon et al. 2019The lancet. Diabetes & endocrinologycited by 272

PMID 31189517DOI 10.1016/s2213-8587(19)30192-5PUB-31189517

Full text at the publisher

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial * Male or female, age above or equal to 18 years at the time of signing informed consent * Diagnosed with type 2 diabetes mellitus for at least 90 days prior to day of screening * HbA1c (glycosylated haemoglobin) of 7.0-9.5% (53-80 mmol/mol) (both inclusive) * Moderate renal impairment defined as estimated glomerular filtration rate of 30-59 mL/min/1.73 m\^2 as per Chronic Kidney Disease Epidemiology Collaboration formula * Stable daily dose(s) within 90 days prior to the day of screening of any of the following treatment regimens: * 1-2 of the following oral anti-diabetic drugs: * Metformin equal or above 1500 mg or maximum tolerated dose documented in the subject medical record), * Sulfonylurea (equal or above half of the maximum approved dose according to local label or maximum tolerated dose as documented in subject medical record) * Basal insulin alone (20% change in total daily dose of insulin glargine, insulin detemir, insulin degludec or NPH insulin) or * Metformin (equal or above 1500 mg or maximum tolerated dose documented in the subject medical record) in combination with basal insulin (20% change in total daily dose of insulin glargine, insulin detemir, insulin degludec or NPH insulin) Exclusion Criteria: * Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using an adequate contraceptive method (adequate contraceptive measure as required by local regulation or practice). For certain specific countries: Additional specific requirements apply * Any disorder, which in the investigator's opinion might jeopardise subject's safety or compliance with the protocol * Family or personal history of Multiple Endocrine Neoplasia Type 2 or Medullary Thyroid Carcinoma * History of pancreatitis (acute or chronic) * History of major surgical procedures involving the stomach potentially affecting absorption of trial product (e.g. subtotal and total gastrectomy, sleeve gastrectomy, gastric bypass surgery) * Any of the following: myocardial infarction, stroke or hospitalisation for unstable angina or transient ischaemic attack within the past 180 days prior to the day of screening and randomisation * Subjects presently classified as being in New York Heart Association Class IV * Planned coronary, carotid or peripheral artery revascularisation known on the day of screening * Subjects with alanine aminotransferase above 2.5 x upper normal limit * Rapidly progressing renal disease (e.g. such as acute glomerulonephritis) as judged by the investigator or known nephrotic albuminuria (above 2200 mg/24 hours or above 2200 mg/g) * Use of systemic immunosuppressive treatment within 90 days prior to screening * Treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria in a period of 90 days before the day of screening. An exception is short-term insulin treatment for acute illness for a total of below or equal to 14 days * Known hypoglycaemic unawareness and/or recurrent severe hypoglycaemic episodes as judged by the investigator * Proliferative retinopathy or maculopathy requiring acute treatment. Verified by fundus photography or dilated fundoscopy performed within 90 days prior to randomisation * History or presence of malignant neoplasms within the last 5 years (except basal and squamous cell skin cancer and carcinoma in situ)

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