Phase 3 · Semaglutide

PIONEER PLUS trial results

Efficacy and Safety of Once-daily Oral Semaglutide 25 mg and 50 mg Compared With 14 mg in Subjects With Type 2 Diabetes

Change From Baseline in Glycated Haemoglobin (HbA1c) (Week 52) (Percentage point of HbA1c), Baseline (week 0), week 52. Oral Semaglutide 14 mg: -1.5; Oral Semaglutide 25 mg: -1.9; Oral Semaglutide 50 mg: -2.1.

Participants
1,606
Status
completed
Completed
2023-03-08
Sponsor
Novo Nordisk A/S

As posted on ClinicalTrials.gov (NCT04707469), updated at source Dec 9, 2025. Read again whenever the registry updates it. Registry figures can differ from a published paper, which may use another analysis.

Primary outcome

What PIONEER PLUS measured first

Change From Baseline in Glycated Haemoglobin (HbA1c) (Week 52)Percentage point of HbA1c · Baseline (week 0), week 52 · mean
Oral Semaglutide 14 mgn=497Oral Semaglutide 25 mgn=475Oral Semaglutide 50 mgn=492
-1.5(1.3)-1.9(1.3)-2.1(1.4)
Side effects by arm

Side effects in PIONEER PLUS

Percent of participants affected, Week 0 to week 73. The most common events the registry lists.

EventOral Semaglutide 14 mgOral Semaglutide 25 mgOral Semaglutide 50 mg
Any serious event9.9%10.7%8.2%
Nausea18%27.2%27.3%
Vomiting9.7%17%18.2%
Diarrhoea12.4%12.9%14.2%
COVID-1911.8%12%12.4%
Decreased appetite7.1%7.3%10.9%
Diabetic retinopathy7.7%4.9%6.6%
Constipation7.5%6.6%6.2%
Headache6.4%5.2%7.1%
Abdominal pain upper2.6%6%4.1%
Dyspepsia5.2%5.4%5.6%
Abdominal pain2.6%5.1%3.9%
Nasopharyngitis4.5%4.1%5.1%
Secondary outcomes

What else it measured

Change From Baseline in Body Weight (Week 52)Kilogram (Kg) · Baseline (week 0), week 52 · mean
Oral Semaglutide 14 mgn=503Oral Semaglutide 25 mgn=480Oral Semaglutide 50 mgn=495
-4.4(5.2)-7.1(6.8)-8.3(7.5)
Change From Baseline in HbA1c (Week 68)Percentage point of HbA1c · Baseline (week 0), week 68 · mean
Oral Semaglutide 14 mgn=487Oral Semaglutide 25 mgn=469Oral Semaglutide 50 mgn=491
-1.5(1.3)-1.8(1.3)-2.0(1.4)
Change From Week 12 in HbA1c (Week 52)Percentage point of HbA1c · Week 12, Week 52 · mean
Oral Semaglutide 14 mgn=333Oral Semaglutide 25 mgn=345Oral Semaglutide 50 mgn=339
-0.4(1.2)-0.8(1.1)-1.0(1.2)
Change From Baseline in Fasting Plasma Glucose (FPG) (Week 52)millimole per litre (mmol/L) · Baseline (week 0), week 52 · mean
Oral Semaglutide 14 mgn=494Oral Semaglutide 25 mgn=460Oral Semaglutide 50 mgn=482
-2.4(3.4)-3.0(3.5)-3.2(3.4)
Change From Baseline in FPG (Week 68)mmol/L · Baseline (week 0), week 68 · mean
Oral Semaglutide 14 mgn=485Oral Semaglutide 25 mgn=466Oral Semaglutide 50 mgn=485
-2.4(3.4)-3.0(3.7)-3.2(3.4)
Percentage of Participants Who Achieved HbA1c Less Than (<) 7.0 (Percent [%]) (Week 52)Percentage of Participants · At week 52 · number
Oral Semaglutide 14 mgn=536Oral Semaglutide 25 mgn=535Oral Semaglutide 50 mgn=535
3950.563
Percentage of Participants Who Achieved HbA1c < 7.0 % (Week 68)Percentage of Participants · At week 68 · number
Oral Semaglutide 14 mgn=536Oral Semaglutide 25 mgn=535Oral Semaglutide 50 mgn=535
39.249.958.9
Percentage of Participants Who Achieved HbA1c Less Than or Equal to (<=) 6.5 % (Week 52)Percentage of Participants · At week 52 · number
Oral Semaglutide 14 mgn=536Oral Semaglutide 25 mgn=535Oral Semaglutide 50 mgn=535
25.839.651.2
Percentage of Participants Who Achieved HbA1c <= 6.5 % (Week 68)Percentage of Participants · At week 68 · number
Oral Semaglutide 14 mgn=536Oral Semaglutide 25 mgn=535Oral Semaglutide 50 mgn=535
23.635.846.2
Time to Event Analyses of Rescue MedicationWeeks · Baseline (week 0), week 68 · median
Oral Semaglutide 14 mgn=92Oral Semaglutide 25 mgn=54Oral Semaglutide 50 mgn=48
NA(NA to NA)NA(NA to NA)NA(NA to NA)
Change From Baseline in Body Weight (Week 68)Kg · Baseline (week 0), week 68 · mean
Oral Semaglutide 14 mgn=495Oral Semaglutide 25 mgn=477Oral Semaglutide 50 mgn=495
-4.5(5.5)-7.1(7.4)-8.2(8.1)
Percentage Change From Baseline in Body Weight (Week 52)Percentage change in body weight · Baseline (week 0), week 52 · mean
Oral Semaglutide 14 mgn=503Oral Semaglutide 25 mgn=480Oral Semaglutide 50 mgn=495
-4.7(5.4)-7.3(6.6)-8.5(7.3)
The trial

How PIONEER PLUS was run

This study compares three doses of once daily semaglutide tablets in people with type 2 diabetes who were previously treated with other oral anti-diabetic medicines. Participants will be initiated on the lowest starting dose of 3 mg and gradually increased until they reach the final trial dose of 14 mg, 25 mg or 50 mg once daily semaglutide tablets. The final three doses will be randomized (i.e., decided by chance). Participants will be administered one tablet per day for 68 weeks. Women cannot take part if they are pregnant, breast-feeding or planning to become pregnant during the study period. Women who can get pregnant will be checked for pregnancy via urine tests. Once daily semaglutide tablets (3 mg, 7 mg and 14 mg) are approved for the treatment of type 2 diabetes in the US, in the EU and in some other countries, under the brand name Rybelsus®.

  • Oral semaglutide 50 mg: Participants will receive once daily semaglutide tablets in a dose escalating manner for 68 weeks: 3 mg (week 1-4), 7 mg (week 5-8), 14 mg (week 9-12), 25 mg (week 13-16) and 50 mg (week 17-68).
  • Oral semaglutide 25 mg: Participants will receive once daily semaglutide tablets in a dose escalating manner for 68 weeks: 3 mg (week 1-4), 7 mg (week 5-8), 14 mg (week 9-12) and 25 mg (week 13-68).
  • Oral semaglutide 14 mg: Participants will receive once daily semaglutide tablets in a dose escalating manner for 68 weeks: 3 mg (week 1-4), 7 mg (week 5-8) and 14 mg (week 9-68).
Who could join the trial

Inclusion Criteria: * Male or female, age above or equal to 18 years at the time of signing informed consent. * Diagnosed with type 2 diabetes mellitus at least 180 days prior to the day of screening. * HbA1c of 8.0-10.5% (64-91 mmol/mol) (both inclusive). * BMI equal to or above 25 kg/m\^2 * Stable daily dose(s) for 90 days prior to the day of screening of any of the following treatment regimens: * No more than 3 of the following oral anti-diabetic drugs and at least 1 marked with a \*: * Metformin (equal to or above1500 mg or maximum tolerated or effective dose). * Sulfonylureas (SU) (equal to or above half of the maximum approved dose according to local label or maximum tolerated or effective dose). * Sodium/glucose cotransporter 2 (SGLT2) inhibitors (maximum tolerated dose). * Dipeptidyl peptidase-4 (DPP-4) inhibitors (maximally indicated dose as per local label). * Subjects, on treatment with stable dose of DPP-4 inhibitors at inclusion, must be willing to discontinue DPP-4 inhibitor treatment at randomisation (with no wash-out). Exclusion Criteria: * Treatment with any medication indicated for the treatment of diabetes or obesity other than stated in the inclusion criteria within the past 90 days prior to the day of screening. However, short term insulin treatment for a maximum of 14 days prior to the day of screening is allowed. * Renal impairment measured as estimated glomerular filtration rate (eGFR) value of below 30 mL/min/1.73 m\^2 according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation as defined by kidney disease improving global outcomes (KDIGO 2012) classification. * Uncontrolled and potentially unstable diabetic retinopathy or maculopathy. Verified by a fundus examination performed within the past 90 days prior to screening or in the period between screening and randomisation. Pharmacological pupil-dilation is a requirement unless using a digital fundus photography camera specified for non-dilated examination.

Published papers

Papers from PIONEER PLUS

Trial averages do not predict what one person will experience. Results are shown as the registry posts them, without interpretation.

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