Semaglutide Demonstrates Enhanced Walking Capacity in ACC.25 STRIDE Data

With weekly semaglutide treatment, patients with peripheral artery disease (PAD) and type 2 diabetes exhibited improved functional capacity when compared with placebo. The latest findings from the phase 3b, randomized, placebo-controlled, double-blind STRIDE trial (NCT04560998) were presented at the American College of Cardiology 2025 Annual Scientific Session.

Maximum walking distance, measured by analyzing the estimated median ratio to baseline in the intervention group (1.21; IQR, 0.95-1.55) and the placebo group (1.08; IQR, 0.86-1.36), significantly increased in the intervention group by week 52 (1.13; 95% CI, 1.06-1.21; P = .0004).

At the meeting, The American Journal of Managed Care^® spoke about the findings with STRIDE investigator Marc P. Bonaca, MD, MPH, executive director of CPC Clinical Research and director of Vascular Research, professor in the Division of Cardiology at the University of Colorado School of Medicine. Bonaca highlighted how these data could provide insight into prioritizing treatment options for this patient population, as accessibility to glucagon-like peptide-1 (GLP-1) receptor agonists and additional medications can vary across subgroups.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What lessons can be drawn from the STRIDE trial in terms of addressing health care inequities, both in clinical trial representation and in real-world treatment access?

STRIDE was a global trial; we had a truly global representation. In terms of the US enrollment, it was really difficult, and the reason it was difficult in the US is that we have high rates of revascularization procedures. We do that early because there are a multitude of drivers that facilitate early revascularization. So, the US enrollment was around 15% to 20%, but it was less than what we'd expect. And so, the diversity, from a US perspective, was less than we had hoped for.

Nonetheless, we have important data in key subgroups; we know in women, there was a statistically significant benefit, even though [they were] 25% of the population. We have a large group of patients from Asia that all showed benefits—so that's good. I think, in general, we need to do better in trials about being inclusive. Nonetheless, there was no heterogeneity based on any region, sex, or racial or ethnic group, which was good.

In terms of access, you ask a really important question: I think that it's too hard to get access to effective therapies. One of the questions we have to ask is how to prioritize; if you're in the clinic with a patient and they can't afford the 8 drugs that are all indicated, how do you prioritize? I think STRIDE helps us here because among the various drugs for diabetes, if your patient has PAD, you might prioritize a GLP-1 receptor agonist, or specifically semaglutide, based on the results of STRIDE. Unfortunately, that's something we have to do with a lot of patients. I also think that there's a huge amount of development here with small molecules, oral therapies, and others and that as GLP-1 drugs become more accessible, these data will be actionable as well, so hopefully, we'll be able to reach more patients in a more equitable way.

Reference

Bonaca MP, Catarig A-M, Houlind K, et al. Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial. The Lancet. Published online March 29, 2025. doi:10.1016/S0140-6736(25)00509-4