Ozempic
Ozempic
Seminggu Sekali
Agonis Reseptor GLP-1 Seminggu Sekali
Pertama dan Satu-satunya yang Menyatukan
Efikasi Superior1 dengan Manfaat
Kardiovaskular2,3 di Indonesia
Kenyamanan pemberian
seminggu sekali4
Outline
Makanan
masuk
Usus halus
Sebagai respon
terhadap makanan
Enzim
DPP-4
GLP-1
Degra
dasi GLP-1 tidak aktif
Reseptor GLP-1
Peningkatan
Penurunan serapan
reabsorpsi glukosa
glukosa
Makanan
masuk
Usus halus
Sebagai respon
terhadap makanan
Enzim
DPP-4
GLP-1
GLP-1 RA Degrad
asi GLP-1 tidak aktif
Menambah kadar GLP-1, lebih
resisten terhadap degradasi enzim
DPP-4
Reseptor GLP-1
DM, diabetes mellitus; DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide-1; GLP-1 RA, GLP-1 receptor agonist
1. Drucker D & Nauck MA. Lancet 2006;368:1696–705
Terapi GLP-1 RA memiliki efek multi faktorial
Berat badan6
Pengosongan Asupan makan5
lambung11 Rasa kenyang7,8
Fungsi sel beta5
Kematian sel beta5
Biosintesis insulin5
Sekresi insulin Lipotoksisitas9
(glucose-dependent)5
Exenatide ER (4.19 kDa, 53% homologi) Semaglutide (4.11 kDa, 94% homologi)
Seminggu Sekali Seminggu Sekali
OH
CO
Phe Phe
Ile Ala Trp Leu Val Arg Gly Arg Gly
Ile GluTrpLeuLysAspGlyGly Pro Ser SerGlyAlaPro Pro Pro Ser
GLP-1, glucagon-like peptide-1; GLP-1 RA, glucagon-like peptide-1 receptor agonist; IgG4 Fc, immunoglobulin-G4 fragment crystallisable; kDa, kilodalton.
*Hanya mencakup GLP-1 RA yang sudah mendapatkan Nomor Ijin Edar di Indonesia per 1 April 2021
1. Diadaptasi dari Andersen A et al. Nat Rev Endocrinol 2018;14:390–403
11
spacer
Lys Ala Ala Gln Gly Glu Leu Tyr Ser
Glu
Spacer and C-18 fatty diacid chain 26
memberikan ikatan yang kuat dengan albumin 3 Phe 34
Ile Arg Gly Arg Gly
Ala Trp Leu Val Lys
GLP-1 RA, glucagon-like peptide-1 receptor agonist; t1/2= half-life; DPP-4=dipeptidyl peptidase-4.
1. Ozempic® Indonesia Prescribing Information. 2021; 2. Dhruv UA et al. JCD. 2016;2:18-25. 3. Kapitza C et al. J Clin Pharmacol. 2015;55(5):497-504;
4. Lau J et al. J Med Chem 2015;58:7370–80.
12
Semaglutide
memiliki 6-kali
ikatan dengan
t1/2, mean
(min.;max.):
albumin yang
149 h (126;189) lebih kuat
daripada
liraglutide2
Assessment of plasma semaglutide level was conducted after 12 weeks of treatment at 1.0 mg steady state in subjects with T2D (n=37). Data are presented as
mean (standard deviation). Horizonal line indicates lower limit of quantification
PK, pharmacokinetic; t1/2, half-life
Kapitza C et al. Diabetologia 2017;60:1390–9; 2. Lau J et al. J Med Chem 2015;58:7370–80.
13
79 † 73*
78* 66* 67
45
38
36
Ozempic® Sitagliptin Ozempic® Canagliflozin Ozempic® Dulaglutide Ozempic® IGlar U100
1,0 mg 100 mg 1,0 mg 300 mg 1,0 mg 1,5 mg 1,0 mg 29U ‡
*P<0.0001; ‡Mean insulin glargine dose at the end of treatment was 29.2 U/day (SD 16.0)
DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin;
SGLT-2i, sodium–glucose cotransporter-2 inhibitor, MET, metformin, TZD, thiazolidinedione, SU, sulfonilurea
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes Endocrinol 2019;7:11 p834-844; 3.
Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al. Lancet Diabetes Endocrinol 2017;5:355–366
14
-0,5 45
-0,8 38
-1,0
36 -1,4
-1,6* -1,5* -1,6*
-1,8*
*P<0.0001; ‡Mean insulin glargine dose at the end of treatment was 29.2 U/day (SD 16.0)
DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin;
SGLT-2i, sodium–glucose cotransporter-2 inhibitor, MET, metformin, TZD, thiazolidinedione, SU, sulfonilurea
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes Endocrinol 2019;7:11 p834-844; 3.
Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al. Lancet Diabetes Endocrinol 2017;5:355–366
15
63*
62* 51*
51*
47
30
18
5
Ozempic ®
Sitagliptin Ozempic® Canagliflozin Ozempic® Dulaglutide Ozempic® IGlar U100
1,0 mg 100 mg 1,0 mg 300 mg 1,0 mg 1,5 mg 1,0 mg 29U ‡
*P<0.0001; ‡Mean insulin glargine dose at the end of treatment was 29.2 U/day (SD 16.0)
DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin;
SGLT-2i, sodium–glucose cotransporter-2 inhibitor, MET, metformin, TZD, thiazolidinedione, SU, sulfonilurea
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes Endocrinol 2019;7:11 p834-844; 3.
Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al. Lancet Diabetes Endocrinol 2017;5:355–366
16
45 +1,2
-1,9 36
-3,0
-4,2 -5,3 †
-5,2*
-6,1* -6,5*
*P<0.0001; ‡Mean insulin glargine dose at the end of treatment was 29.2 U/day (SD 16.0)
DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin;
SGLT-2i, sodium–glucose cotransporter-2 inhibitor, MET, metformin, TZD, thiazolidinedione, SU, sulfonilurea
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes Endocrinol 2019;7:11 p834-844; 3.
Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al. Lancet Diabetes Endocrinol 2017;5:355–366
17
93.0
Penurunan berat badan dipertahankan selama 2 tahun 1*
92.0
−0.5 kg
−0.7 kg
91.0
Berat badan (kg)
90.0
89.0
−3.6 kg
88.0
0 8 16 30 44 56 68 80 92 104
Durasi (minggu)
74* 74*
64*
60* 58
40
27
16
Ozempic® Sitagliptin Ozempic® Canagliflozin Ozempic® Dulaglutide Ozempic® IGlar U100
1,0 mg 100 mg 1,0 mg 300 mg 1,0 mg 1,5 mg 1,0 mg 29U ‡
*P<0.0001; ‡Mean insulin glargine dose at the end of treatment was 29.2 U/day (SD 16.0)
DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin;
SGLT-2i, sodium–glucose cotransporter-2 inhibitor, MET, metformin, TZD, thiazolidinedione, SU, sulfonilurea
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes Endocrinol 2019;7:11 p834-844; 3.
Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al. Lancet Diabetes Endocrinol 2017;5:355–366
19
N=3297
*Semaglutide reduced the risk of CV events by 26% beyond standard of care compared with placebo in patients with T2D at high CV risk;
†
MACE: Composite endpoint comprising the first occurrence of CV death, non-fatal myocardial infarction or non-fatal stroke using ‘in-trial’ data from subjects in the full
analysis set. Hazard ratio is from a stratified proportional hazards model; ‡patients aged 55 years or older with coronary, carotid or lower extremity artery stenosis
>50%, left ventricular hypertrophy, an eGFR <60 ml min−1 [1.73 m]−2 or albuminuria
CI, confidence interval; CV, cardiovascular; DM, diabetes mellitus; EAC, event adjudication committee; MACE, major adverse
cardiovascular event; SoC, standard of care; OW, once-weekly
1. Marso SP et al. N Engl J Med 2016;375:1834–1844
20
N=3297
*Semaglutide reduced the risk of new events of nephropathy or worsening nephropathy by 36% beyond standard of care compared with placebo in patients with
T2D at high CV risk. Data based on SUSTAIN 6 CVOT
CV, cardiovascular; CI, confidence interval; HR, hazard ratio; T2D, Type 2 Diabetes
1. Marso SP et al. N Engl J Med 2016;375:1834–1844
21
*Di Indonesia
BB, berat badan; GLP-1RA, glucagon-like peptide type-1 receptor agonist; HbA1c, glycosylated haemoglobin; MACE, major adverse cardiovascular event
1. Ahrén B et al. Lancet Diabetes Endocrinol 2017;5:341–354; 2. Lingvay I et al. Lancet Diabetes
Endocrinol 2019;7:11 p834-844; 3. Pratley RE et al. Lancet Diabetes Endocrinol 2018;6:275–286; 4. Aroda V et al.
Lancet Diabetes Endocrinol 2017;5:355–366; 5. Marso SP et al. N Engl J Med 2016;375:1834–44; 6. Kruk M, et al.
2
0,25 mg 0,5 mg 1 mg
seminggu sekali seminggu sekali seminggu sekali
Untuk dosis awal Untuk minimal Untuk meningkatkan
4 minggu 4 minggu kontrol glikemik
pertama selanjutnya lebih jauh
Dikutip dari: PT Asuransi Jiwa Inhealth Indonesia. Formularium Obat Inhealth edisi XV tahun
FOR HEALTHCARE PROFESSIONALS ONLY
2023 Dengan Harga (halaman 111); 2023
30
Penggunaan Ozempic®
Penggunaan Ozempic®
Penggunaan Ozempic®
*Ozempic® dapat diinjeksikan pada bagian abdomen, paha dan lengan atas 2
1. Frid A., et al. New injection recommendations for patients with diabetes. Diabetes & Metabolism 2010;36:S3-S18;
2. Ozempic® Indonesia Prescribing Information 2021
2
• Metformin, atau
• Metformin dan Sulfonilurea, atau
• Metformin dan Insulin basal
SU, sulfonilurea
Populasi Khusus
Tipe Pasien Pertimbangan
• Dapat diberikan tanpa penyesuaian dosis
Pasien lansia
• Pengalaman terapi pada pasien >= 75 tahun terbatas
• Dapat diberikan kepada pasien dengan gangguan ginjal ringan,
sedang dan berat, tanpa penyesuaian dosis
Gangguan ginjal
• Pengalaman penggunaan semaglutide pada pasien dengan
gangguan ginjal berat terbatas.
• Dapat diberikan kepada pasien dengan gangguan hati tanpa
penyesuaian dosis
Gangguan hati • Pengalaman penggunaan pada pasien dengan gangguan hati berat
terbatas. Kehati-hatian harus dilakukan saat penggunaan
semaglutide pada pasien tersebut.
Efek Samping:
• Sangat umum (>=1/10) : Mual dan diare, serta hipoglikemia ketika digunakan
bersama insulin atau sulfonilurea
• Umum (>=1/100 - < 1/10): Hipoglikemia ketika digunakan dengan obat oral
antidiabetes lainnya, penurunan nafsu makan, rasa pusing, Komplikasi retinopati
diabetes, mual, nyeri perut, distensi perut, konstipasi, dispepsia, gastritis, GERD,
sendawa, flatulensi, cholelithiasis, rasa lelah, peningkatan lipase, peningkatan amilase,
berat badan turun
PENINGKATAN DOSIS
MENANGANI KONSTIPASI SECARA BERTAHAP
• Minum cairan yang banyak6 DAPAT MENGURANGI
• Meningkatkan konsumsi serat6 EFEK SAMPING7
• Olahraga secara teratur6
1. Ozempic® Indonesia Prescribing Information 2021; 2. Blundell J et al. Diabetes Obes Metab 2017;19:1242–51. 3. Shomali M. Clin Diabetes 2014;32:32–43. 4. Cleveland Clinic.
Nausea & Vomiting: Care and Treatment. Available from: https://my.clevelandclinic.org/health/symptoms/8106-nausea--vomiting/care-and-treatment. 5. Health Direct. Diarrhoea.
Available from: https://www.healthdirect.gov.au/diarrhoea#treated. 6. Cleveland Clinic. Constipation: Management and Treatment. Available from:
https://my.clevelandclinic.org/health/diseases/4059-constipation/management-and-treatment. 7. Nauck MA et al. Diabetes Care 2016;39:231–41.
40
Boleh: Tidak:
Setiap pena Ozempic® hanya dapat digunakan X Penggunaan pena Ozempic® lebih dari 6 minggu
selama 6 minggu setelah penyuntikan pertama setelah penyuntikan pertama
Simpan pena baru dalam kulkas X Meletakkan pena dan terpapar sinar matahari
(suhu 20C – 80C) langsung atau panas yang berlebihan (>300C)
Pena yang sudah digunakan dapat disimpan di X Membekukan pena Ozempic® Anda
bawah suhu 300C atau di dalam kulkas
(suhu 20C – 80C) X Menggunakan pena yang sudah dibuka selama
lebih dari 6 minggu, berwarna atau
Jauhkan pena Anda dari debu, kotoran dan segala terkontaminasi
macam cairan
X Bergantian menggunakan pena atau jarum
Membersihkan bagian luar pena dengan kain yang dengan orang lain
lembap
X Meletakkan atau menyimpan pena dengan jarum
Gunakan jarum baru tiap penyuntikan terpasang
Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2021. PERKENI 2021.
Laporan Konsensus ADA/EASD 2022
Remarks: Some molecules and indications are not yet approved in Indonesia.
This is for educational purpose only
ACEi, angiotensin-converting enzyme inhibitor; ACR, albumin/creatinine ratio; ARB, angiotensin receptor blocker; ASCVD, atherosclerotic cardiovascular disease; CAD, coronary artery disease; CGM, continuous glucose
monitoring; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; eGFR, estimated glomerular filtration rate; GLP-1 RA,
glucagon-like peptide 1 receptor agonist; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HHF, hospitalization for heart failure; MACE, major adverse
cardiovascular events; MI, myocardial infarction; SDOH, social determinants of health; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes; TZD, thiazolidinedione. Davies MJ. et al,
Diabetes Care 2022; https://doi.org/10.2337/dci22-0034
FOR HEALTHCARE PROFESSIONALS ONLY
Ozempic®
Seminggu Sekali
Agonis Reseptor GLP-1 Seminggu Sekali
Pertama dan Satu-satunya yang Menyatukan
Efikasi Superior1 dengan Manfaat
Kardiovaskular2,3 di Indonesia
Kenyamanan pemberian
seminggu sekali4