The "Can Semaglutide or eMpAgliflozin Stabilise coronary atHerosclerosis after Acute Coronary Syndrome (SMASH-ACS)” study in people with type 2 diabetes

This was an open-label, interventional study comparing semaglutide (a glucagon-like peptide-1 receptor agonist (GLP-1 RA) which was going to be self-administered subcutaneously by the patient (starting at 0.25mg/week, uptitrated on a monthly basis based on patient tolerance and at the direction of a physician, up to 1.0 mg/week as tolerated). The comparator was empagliflozin (a sodium-glucose co-transporter-2 (SGLT2) inhibitor), with a starting dose of 10mg daily, which could have been uptitrated to 25mg daily at 3 months at clinician discretion. Participants underwent baseline CT coronary angiogram (CTCA), and after continuing treatment for 12 month, underwent a CTCA at 12 months. Adherence was assessed by patient report at 1, 2, 3, 6, 9, and 12 months. The primary endpoint for this study was progression rates of low attenuation plaque under influence of GLP-1 RA as compared to SGLT2 inhibition as assessed by CT coronary angiography. The study was stopped early due to change in PBS eligibility for drug being tested.