Glucagon-like peptide-1 receptor agonist in large vessel occlusion treated by reperfusion therapy—a phase 2 randomized trial

We aimed to determine the effect of semaglutide on patients with acute large vessel occlusion (LVO) receiving endovascular therapy (EVT). In this phase 2, investigator-initiated, multicenter, prospective, randomized, open-label, blinded endpoint trial conducted in China, we recruited patients with disabling LVO undergoing EVT. Patients were randomized to semaglutide therapy (0.5 mg subcutaneous semaglutide before and 1 week after EVT) or standard therapy. The primary outcome was defined as favorable neurological recovery (modified Rankin Scale 0-2 at 90 days). Between August 2023 and July 2024, 140 patients were randomized to semaglutide (n = 69) or standard therapy (n = 71). The primary outcome occurred in 39 (56.5%) in the semaglutide group and 39 (54.9%) in the standard therapy group (adjusted RR 1.05, 95% CI 0.95-1.15, p = 0.37). We observed treatment effect modification by intravenous thrombolysis (IVT) on semaglutide therapy (p<sub>interaction</sub> = 0.02); thus we performed the following exploratory analyses: The primary outcome occurred in 22 (64.7%) in the semaglutide group and 15 (44.1%) in the standard therapy group (adjusted RR 1.18, 95% CI 1.02-1.36) in the no-IVT stratum (n = 68). The primary outcome was similar between two groups in the IVT-stratum. No severe adverse event was attributed to semaglutide treatment. This phase 2 trial suggested semaglutide was safe in patients with LVO and was associated with an improved neurological outcome in patients not receiving IVT. These preliminary observations should be confirmed in a phase 3 randomized trial (ClinicalTrials.gov Identifier: NCT05920889).

Authors

Institutions

Publication Details

Journal
Nature Communications
Published
2025-12-14
DOI
https://doi.org/10.1038/s41467-025-66167-z
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Glucagon-like peptide-1 receptor agonist in large vessel occlusion treated by reperfusion therapy—a phase 2 randomized trial

Sze Ho, Rosa H. M. Chan, Junjie Sai, Shuk Yi Annie Hui et al.
Nature Communications
Acute Ischemic Stroke Management
article

Glucagon-like peptide-1 receptor agonist in large vessel occlusion treated by reperfusion therapy—a phase 2 randomized trial

Sze Ho, Rosa H. M. Chan, Junjie Sai, Shuk Yi Annie Hui, Vincent Mok, Chung‐Ming Chu, Terry Cheuk‐Fung Yip, Siu Hung Li, Thomas Leung, Florence Fan, Suk Fung Tsang, Bonaventure Ip, Lei Lui, Xinyi Leng, Wentao Zang, Andrew Kwok, Thanh N. Nguyen, Jill Abrigo, Bonnie Lam, Wei Hu, Charlie Chan, Qiang Cao, Jason Wong, Ho Sang Leung, Haipeng Li, Jie Zhang, Hao Wang, Liang Yu, Fengyuan Che, Kainam Thomas Wong, Sangqi Pan, Joseph Choi, Howan Leung, Junzhe Huang, Ho Ko, Jonas Yeung, Trista Hung, Anne Chan, Yannie Soo, Karen Ma, Billy Lai, Yinfei Li, Vincent Ip, Larry Chan, Wai Ting Lui, Tom Cheung
article en

Abstract

We aimed to determine the effect of semaglutide on patients with acute large vessel occlusion (LVO) receiving endovascular therapy (EVT). In this phase 2, investigator-initiated, multicenter, prospective, randomized, open-label, blinded endpoint trial conducted in China, we recruited patients with disabling LVO undergoing EVT. Patients were randomized to semaglutide therapy (0.5 mg subcutaneous semaglutide before and 1 week after EVT) or standard therapy. The primary outcome was defined as favorable neurological recovery (modified Rankin Scale 0-2 at 90 days). Between August 2023 and July 2024, 140 patients were randomized to semaglutide (n = 69) or standard therapy (n = 71). The primary outcome occurred in 39 (56.5%) in the semaglutide group and 39 (54.9%) in the standard therapy group (adjusted RR 1.05, 95% CI 0.95-1.15, p = 0.37). We observed treatment effect modification by intravenous thrombolysis (IVT) on semaglutide therapy (p<sub>interaction</sub> = 0.02); thus we performed the following exploratory analyses: The primary outcome occurred in 22 (64.7%) in the semaglutide group and 15 (44.1%) in the standard therapy group (adjusted RR 1.18, 95% CI 1.02-1.36) in the no-IVT stratum (n = 68). The primary outcome was similar between two groups in the IVT-stratum. No severe adverse event was attributed to semaglutide treatment. This phase 2 trial suggested semaglutide was safe in patients with LVO and was associated with an improved neurological outcome in patients not receiving IVT. These preliminary observations should be confirmed in a phase 3 randomized trial (ClinicalTrials.gov Identifier: NCT05920889).

Nature CommunicationsVol. 16(1)
University of Science and Technology of China (CN), Boston Medical Center (US), City University of Hong Kong (HK), Chinese University of Hong Kong (HK), Alice Ho Miu Ling Nethersole Hospital (CN), Linyi People's Hospital (CN)
Openalex Percentile: Top 48%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.