` ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙CONTRAINDICATIONS∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`
`
`
`
` Personal or family history of medullary thyroid carcinoma or in patients
`•
` with Multiple Endocrine Neoplasia syndrome type 2 (4).
`
`
` Known hypersensitivity to OZEMPIC or any of the product components
`
`
`
`
`
` (4).
`
`
`•
`
`
`
`
`
`
`•
`
`
`•
`
`
`•
`
`
`•
`
`
`•
`
`
` ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙WARNINGS AND PRECAUTIONS∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`
`
`
`
`
` Pancreatitis: Has been reported in clinical trials. Discontinue promptly if
`•
`pancreatitis is suspected. Do not restart if pancreatitis is confirmed (5.2).
`
`
`
`
`
`Diabetic Retinopathy Complications: Has been reported in a clinical trial.
`
`
`
`
`
`Patients with a history of diabetic retinopathy should be monitored (5.3).
`
`
`
`
`Never share an OZEMPIC pen between patients, even if the needle is
`
`
`
`
`changed (5.4).
`
`Hypoglycemia: When OZEMPIC is used with an insulin secretagogue or
`
`
`
`
`
`
`
`insulin, consider lowering the dose of the secretagogue or insulin to reduce
`
`
`
`the risk of hypoglycemia (5.5).
`
`
`Acute Kidney Injury: Monitor renal function in patients with renal
`
`
`
`
`impairment reporting severe adverse gastrointestinal reactions (5.6).
`
`Hypersensitivity Reactions: Discontinue OZEMPIC if suspected and
`
`
`
`
`
`promptly seek medical advice (5.7).
`
`
`• Macrovascular outcomes: There have been no clinical studies establishing
`
`
`
`conclusive evidence of macrovascular risk reduction with semaglutide
`
`
`(5.8).
`
`
`∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ADVERSE REACTIONS∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`
`The most common adverse reactions, reported in ≥5% of patients treated with
`
`
`
`
`
`
`
`OZEMPIC are: nausea, vomiting, diarrhea, abdominal pain and constipation
`
`
`
`(6.1).
`
`
`To report SUSPECTED ADVERSE REACTIONS, contact Novo Nordisk
`
`Inc., at 1-888-693-6742 or FDA at 1-800-FDA-1088 or
`
`
`
`www.fda.gov/medwatch.
`
`
`------------------------------DRUG INTERACTIONS----------------------------------­
`
`Oral Medications: OZEMPIC delays gastric emptying. May impact absorption of
`
`
`
`concomitantly administered oral medications (7.2).
`
`
`
`∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙USE IN SPECIFIC POPULATIONS∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`Females and Males of Reproductive Potential: Discontinue OZEMPIC in women
`
`
`
`
` at least 2 months before a planned pregnancy due to the long washout period for
`
`
`
`
`
`
` semaglutide (8.3).
`
`
`
`
`
`
`
`See 17 for PATIENT COUNSELING INFORMATION and
`
`Medication Guide.
`
`
`
`
`Revised: 04/2019
`
`
` HIGHLIGHTS OF PRESCRIBING INFORMATION
` These highlights do not include all the information needed to use
`
`
`OZEMPIC® safely and effectively. See full prescribing information
`
`
`
`
`
`
`for OZEMPIC.
`
`
`
`
`OZEMPIC (semaglutide) injection, for subcutaneous use
`
`Initial U.S. Approval: 2017
`
`
`
`
`
`•
`
` WARNING: RISK OF THYROID C-CELL TUMORS
`
`
`
` See full prescribing information for complete boxed warning.
`
` In rodents, semaglutide causes thyroid C-cell tumors. It is
`
`
`
` unknown whether OZEMPIC causes thyroid C-cell tumors,
`
`
` including medullary thyroid carcinoma (MTC), in humans as
`
` the human relevance of semaglutide-induced rodent thyroid C-
`
` cell tumors has not been determined (5.1, 13.1).
`
`
`
`• OZEMPIC is contraindicated in patients with a personal or
`
`
`
`
`family history of MTC or in patients with Multiple Endocrine
`
`
`
`
`Neoplasia syndrome type 2 (MEN 2). Counsel patients
`
`
`
`regarding the potential risk of MTC and symptoms of thyroid
`
`
` tumors (4, 5.1).
`
`
`
`
`
`
`
`
`
`
`
`
`
`
` ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙INDICATIONS AND USAGE∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
` OZEMPIC is a glucagon-like peptide 1 (GLP-1) receptor agonist
`
`
` indicated as an adjunct to diet and exercise to improve glycemic control
`
`
`
`
`
` in adults with type 2 diabetes mellitus (1).
`
`
`
`
`
`
`
`
`Limitations of Use:
`Not recommended as first-line therapy for patients inadequately
`
`
`
`•
`controlled on diet and exercise (1, 5.1).
`
`
`Has not been studied in patients with a history of pancreatitis.
`
`
`
`Consider another antidiabetic therapy (1, 5.2).
`
`
`Not indicated for use in type 1 diabetes mellitus or treatment of
`
`
`
`
`
`
`diabetic ketoacidosis (1).
`
`
`
`
`•
`
`
`•
`
`
`∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙DOSAGE AND ADMINISTRATION∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`Start at 0.25 mg once weekly. After 4 weeks, increase the dose to
`
`
`
`
`
`
`
`•
`0.5 mg once weekly. If after at least 4 weeks additional glycemic
`
`
`
`
`control is needed, increase to 1 mg once weekly (2.1).
`
`
`
`
`
`Administer once weekly at any time of day, with or without meals
`
`(2.1).
`
`If a dose is missed administer within 5 days of missed dose (2.1).
`
`
`
`Inject subcutaneously in the abdomen, thigh, or upper arm (2.2).
`
`
`
`
`
`
`•
`
`
`•
`
`•
`
`∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙DOSAGE FORMS AND STRENGTHS∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙
`
`
`
`Injection: 2 mg/1.5 mL (1.34 mg/mL) available in:
`
`
`
`Single-patient-use pen that delivers 0.25 mg or 0.5 mg per injection
`
`
`
`
`
`
`•
`(3).
`
`Single-patient-use pen that delivers 1 mg per injection (3).
`
`
`
`
`
`•
`Injection: 4 mg/3 mL (1.34 mg/mL) available in:
`
`
`
`Single-patient-use pen that delivers 1 mg per injection (3).
`
`
`
`
`
`•
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
`
`

`

`
`
`
`
`
`
`
`
`8
`
`
`13
`
`14
`
`
`
`USE IN SPECIFIC POPULATIONS
`
`
`8.1 Pregnancy
`
`
`8.2 Lactation
`
`
`
`
`8.3 Females and Males of Reproductive Potential
`
`
`
`8.4 Pediatric Use
`
`
`
`8.5 Geriatric Use
`
`
`
`8.6 Renal Impairment
`
`
` Hepatic Impairment
`8.7
`
`
`
`10
`OVERDOSAGE
`
`
`11
`DESCRIPTION
`
`
`12
`CLINICAL PHARMACOLOGY
`
`12.1 Mechanism of Action
`
`12.2 Pharmacodynamics
`
`12.3 Pharmacokinetics
`
`NONCLINICAL TOXICOLOGY
`
`
`13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
`
`CLINICAL STUDIES
`
`14.1 Overview of Clinical Studies
`
`
`
`14.2 Monotherapy Use of OZEMPIC in Patients with Type 2
`
`Diabetes Mellitus
`
`
`
`
`14.3 Combination Therapy Use of OZEMPIC in Patients with Type 2
`
`Diabetes Mellitus
`
`
`
`
`14.4 Cardiovascular Outcomes Trial of OZEMPIC in Patients with
`
`Type 2 Diabetes Mellitus
`
`
`16
`HOW SUPPLIED/STORAGE AND HANDLING
`
`
`17
`PATIENT COUNSELING INFORMATION
`
`
`
`
`
`*Sections or subsections omitted from the full prescribing information are not
`
`listed.
`
` INDICATIONS AND USAGE
`
` DOSAGE AND ADMINISTRATION
`
`
`
` 2.1 Recommended Dosage
`
` 2.2 Important Administration Instructions
` DOSAGE FORMS AND STRENGTHS
`
`
` CONTRAINDICATIONS
`
` WARNINGS AND PRECAUTIONS
`
`
` 5.1 Risk of Thyroid C-Cell Tumors
`
` 5.2 Pancreatitis
`
`
`
`
` 5.3 Diabetic Retinopathy Complications
`
` 5.4 Never Share an OZEMPIC Pen Between Patients
`
`
`
` 5.5 Hypoglycemia with Concomitant Use of Insulin
`
`
`
` Secretagogues or Insulin
`
`
` 5.6 Acute Kidney Injury
`
`
`
`
` 5.7 Hypersensitivity
`
`
` 5.8 Macrovascular Outcomes
` ADVERSE REACTIONS
`
` 6.1 Clinical Trials Experience
`
`
` 6.2 Immunogenicity
`
` DRUG INTERACTIONS
`
`
` 7.1 Concomitant Use with an Insulin Secretagogue (e.g.
`
`
`
`
` Sulfonylurea) or with Insulin
`
` 7.2 Oral Medications
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
` FULL PRESCRIBING INFORMATION: CONTENTS*
`
` WARNING: RISK OF THYROID C-CELL TUMORS
`
`
` 1
`
` 2
`
`
`
`
` 3
`
` 4
`
` 5
`
`
`
` 6
`
`
`
` 7
`
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
`
`

`

`
`
` FULL PRESCRIBING INFORMATION
`
`
`
`•
`
` WARNING: RISK OF THYROID C-CELL TUMORS
`
`
`In rodents, semaglutide causes dose-dependent and treatment-duration-dependent thyroid
` C-cell tumors at clinically relevant exposures. It is unknown whether OZEMPIC causes
`
`
`
`
` thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human
` relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined [see
`
`
`
`
`
` Warnings and Precautions (5.1) and Nonclinical Toxicology (13.1)].
`
`
`
`
`
`
`• OZEMPIC is contraindicated in patients with a personal or family history of MTC or in
`
`patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) [see Contraindications
`
`
`(4)]. Counsel patients regarding the potential risk for MTC with the use of OZEMPIC and
`
`
`
`inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea,
`
`
`persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is
`of uncertain value for early detection of MTC in patients treated with OZEMPIC [see
`
`
`
` Contraindications (4) and Warnings and Precautions (5.1)].
`
`
`
`
`
`
`
`INDICATIONS AND USAGE
`1
`
`OZEMPIC is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2
`
`
`diabetes mellitus [see Clinical Studies (14.1)].
`
`
`Limitations of Use
`
`
`
`• OZEMPIC is not recommended as a first-line therapy for patients who have inadequate glycemic control on
`
`diet and exercise because of the uncertain relevance of rodent C-cell tumor findings to humans [see Warnings
`
`
`and Precautions (5.1)].
`
`
`
`
`
`
`• OZEMPIC has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies
`
`
`
`in patients with a history of pancreatitis [see Warnings and Precautions (5.2)].
`
`
`
`
`
`
`• OZEMPIC is not a substitute for insulin. OZEMPIC is not indicated for use in patients with type 1 diabetes
`
`mellitus or for the treatment of patients with diabetic ketoacidosis, as it would not be effective in these
`
`
`settings.
`
`
`
`
`
`
`
` DOSAGE AND ADMINISTRATION
`2
`
`
`2.1
`
` Recommended Dosage
`
`
` • Start OZEMPIC with a 0.25 mg subcutaneous injection once weekly for 4 weeks. The 0.25 mg dose is
`
`
`
` intended for treatment initiation and is not effective for glycemic control.
`
`
`
` • After 4 weeks on the 0.25 mg dose, increase the dosage to 0.5 mg once weekly.
`
`
` If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dose, the dosage may be
`
`
`
`
`
` increased to 1 mg once weekly. The maximum recommended dosage is 1 mg once weekly.
`
`
`
`
`
`
`
`
`
`
`•
`
`
`
`
`
`
`
`
` • Administer OZEMPIC once weekly, on the same day each week, at any time of the day, with or without
`
` meals.
`
`
`
`
`
`
`
`
`
`
`
`
`
` • The day of weekly administration can be changed if necessary as long as the time between two doses is
`
`
`
`
`
` at least 2 days (>48 hours).
`
`
`
`
`
`
`
`
`•
`
` If a dose is missed, administer OZEMPIC as soon as possible within 5 days after the missed dose. If
`
`
`
`
` more than 5 days have passed, skip the missed dose and administer the next dose on the regularly
` scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.
`
`
`
`
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
`
`

`

`
`
`
`
`
` Important Administration Instructions
`
`2.2
` • Administer OZEMPIC subcutaneously to the abdomen, thigh, or upper arm. Instruct patients to use a
`
`
`
` different injection site each week when injecting in the same body region.
`
`
`
`
`•
`
` Inspect OZEMPIC visually before use. It should appear clear and colorless. Do not use OZEMPIC if
`
`
`
`
`
`
`
` particulate matter and coloration is seen.
`
`
`
`
`
`
`
`
`
` • When using OZEMPIC with insulin, instruct patients to administer as separate injections and to never
`
`
`
`
`
`
`
` mix the products. It is acceptable to inject OZEMPIC and insulin in the same body region but the
` injections should not be adjacent to each other.
`
`
`
`
`
`
`
`
`DOSAGE FORMS AND STRENGTHS
`3
`
`Injection: clear, colorless solution available in 3 pre-filled, disposable, single-patient-use pens:
`
`
`Dose per
` Total Strength
`Strength per
` Use For
` per Total Volume
`
` Injection
` mL
`
`
`
`
`
` 0.25 mg
`
` Initiation
`
`
` 2 mg / 1.5 mL
`
` 0.5 mg
`
` 1.34 mg/mL
`
` Maintenance
`
` 2 mg / 1.5 mL
`
`
` 1.34 mg/mL
`
` Maintenance
` 1 mg
`
`1 mg
`
` 1.34 mg/mL
`
` Maintenance
` 4 mg / 3 mL
`
` CONTRAINDICATIONS
` 4
`
`
` OZEMPIC is contraindicated in patients with:
`
`
`
`
`
`
` • A personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple
` Endocrine Neoplasia syndrome type 2 (MEN 2) [see Warnings and Precautions (5.1)].
`
`
`
`
`
`
`
` • Known hypersensitivity to semaglutide or to any of the product components [see Warnings and
`
` Precautions (5.7)].
`
`
`
`
`
`
`
`WARNINGS AND PRECAUTIONS
`5
`
`
`Risk of Thyroid C-Cell Tumors
`5.1
`
`
`In mice and rats, semaglutide caused a dose-dependent and treatment-duration-dependent increase in the
`incidence of thyroid C-cell tumors (adenomas and carcinomas) after lifetime exposure at clinically relevant
`
`
`plasma exposures [see Nonclinical Toxicology (13.1)]. It is unknown whether OZEMPIC causes thyroid C-cell
`
`
`
`
`tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced
`
`rodent thyroid C-cell tumors has not been determined.
`
`
`
`
`Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist, have been reported in the
`
`
`postmarketing period; the data in these reports are insufficient to establish or exclude a causal relationship
`
`
`between MTC and GLP-1 receptor agonist use in humans.
`
`
`
`OZEMPIC is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2.
`
`Counsel patients regarding the potential risk for MTC with the use of OZEMPIC and inform them of symptoms
`
`
`
`of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness).
`
`
`
`Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of
`
`
`MTC in patients treated with OZEMPIC. Such monitoring may increase the risk of unnecessary procedures, due
`
`
`
`to the low test specificity for serum calcitonin and a high background incidence of thyroid disease. Significantly
`
`elevated serum calcitonin value may indicate MTC and patients with MTC usually have calcitonin values >50
`
`ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients
`
`
`with thyroid nodules noted on physical examination or neck imaging should also be further evaluated.
`
`
`5.2
`
`
`Pancreatitis
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
`
`

`

`In glycemic control trials, acute pancreatitis was confirmed by adjudication in 7 OZEMPIC-treated patients (0.3
`
`
`
`cases per 100 patient years) versus 3 in comparator-treated patients (0.2 cases per 100 patient years). One case
`
`
`
`of chronic pancreatitis was confirmed in an OZEMPIC-treated patient. In a 2-year trial, acute pancreatitis was
`
`
`
`
`
`
`confirmed by adjudication in 8 OZEMPIC-treated patients (0.27 cases per 100 patient years) and 10 placebo-
`
`treated patients (0.33 cases per 100 patient years), both on a background of standard of care.
`
`
`
`After initiation of OZEMPIC, observe patients carefully for signs and symptoms of pancreatitis (including
`
`
`persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied
`by vomiting). If pancreatitis is suspected, OZEMPIC should be discontinued and appropriate management
`
`
`
`
`initiated; if confirmed, OZEMPIC should not be restarted.
`
`
`
`Diabetic Retinopathy Complications
`5.3
`
`
`
`In a 2-year trial involving patients with type 2 diabetes and high cardiovascular risk, more events of diabetic
`
`
`
`retinopathy complications occurred in patients treated with OZEMPIC (3.0%) compared to placebo (1.8%). The
`
`
`
`absolute risk increase for diabetic retinopathy complications was larger among patients with a history of
`
`
`diabetic retinopathy at baseline (OZEMPIC 8.2%, placebo 5.2%) than among patients without a known history
`
`of diabetic retinopathy (OZEMPIC 0.7%, placebo 0.4%).
`
`
`
`Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy.
`
`
`
`The effect of long-term glycemic control with semaglutide on diabetic retinopathy complications has not been
`
`
`studied. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic
`
`retinopathy.
`
`
`Never Share an OZEMPIC Pen Between Patients
`5.4
`
`
`
`
`OZEMPIC pens must never be shared between patients, even if the needle is changed. Pen-sharing poses a risk
`
`
`
`
`for transmission of blood-borne pathogens.
`
`
`5.5 Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin
`
`
`
`
`The risk of hypoglycemia is increased when OZEMPIC is used in combination with insulin secretagogues (e.g.,
`
`sulfonylureas) or insulin. Patients may require a lower dose of the secretagogue or insulin to reduce the risk of
`
`
`
`
`hypoglycemia in this setting [see Adverse Reactions (6.1), Drug Interactions (7.1)].
`
`
`
`
`
`
`Acute Kidney Injury
`5.6
`
`
`
`There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which
`
`
`may sometimes require hemodialysis, in patients treated with GLP-1 receptor agonists. Some of these events
`
`
`
`have been reported in patients without known underlying renal disease. A majority of the reported events
`
`
`
`
`occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Monitor renal function
`
`
`when initiating or escalating doses of OZEMPIC in patients reporting severe adverse gastrointestinal reactions.
`
`
`
`
`
`5.7 Hypersensitivity
`
`
`Serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) have been reported with GLP-1 receptor
`
`agonists. If hypersensitivity reactions occur, discontinue use of OZEMPIC; treat promptly per standard of care,
`and monitor until signs and symptoms resolve. Do not use in patients with a previous hypersensitivity to
`
`
`OZEMPIC [see Contraindications (4)].
`
`
`
`Anaphylaxis and angioedema have been reported with other GLP-1 receptor agonists. Use caution in a patient
`
`with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist because it is unknown
`
`whether such patients will be predisposed to anaphylaxis with OZEMPIC.
`
`
`5.8 Macrovascular Outcomes
`
`
`There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with
`
`OZEMPIC.
`
`
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`Reference ID: 4416585Reference ID: 4525580
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`

`

`
`
`
`ADVERSE REACTIONS
`6
`
`
`
`
`The following serious adverse reactions are described below or elsewhere in the prescribing information:
`
`
`
`• Risk of Thyroid C-cell Tumors [see Warnings and Precautions (5.1)]
`
`
`
`• Pancreatitis [see Warnings and Precautions (5.2)]
`
`
`
`
`
`
`• Diabetic Retinopathy Complications [see Warnings and Precautions (5.3)]
`
`
`
`
`
`
`• Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin [see Warnings and Precautions
`
`
`
`(5.5)]
`
`
`• Acute Kidney Injury [see Warnings and Precautions (5.6)]
`
`
`
`
`• Hypersensitivity [see Warnings and Precautions (5.7)]
`
`
`
`
`
`6.1 Clinical Trials Experience
`
`
`
`Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the
`
`
`
`clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not
`
`reflect the rates observed in practice.
`
`
`Pool of Placebo-Controlled Trials
`The data in Table 1 are derived from 2 placebo-controlled trials (1 monotherapy trial and 1 trial in combination
`
`
`with basal insulin) in patients with type 2 diabetes [see Clinical Studies (14)]. These data reflect exposure of
`
`
`
`521 patients to OZEMPIC and a mean duration of exposure to OZEMPIC of 32.9 weeks. Across the treatment
`
`
`
`
`
`arms, the mean age of patients was 56 years, 3.4% were 75 years or older and 55% were male. In these trials
`
`
`
`
`
`
`
`71% were White, 7% were Black or African American, and 19% were Asian; 21% identified as Hispanic or
`
`
`
`
`
`
`Latino ethnicity. At baseline, patients had type 2 diabetes for an average of 8.8 years and had a mean HbA1c of
`
`
`
`
`
`
`
`8.2%. At baseline, 8.9% of the population reported retinopathy. Baseline estimated renal function was normal
`
`
`
`
`
`(eGFR ≥90 mL/min/1.73m2) in 57.2%, mildly impaired (eGFR 60 to 90 mL/min/1.73m2) in 35.9% and
`
`
`
`
`
`
`moderately impaired (eGFR 30 to 60 mL/min/1.73m2) in 6.9% of patients.
`
`
`
`
`
`Pool of Placebo- and Active-Controlled Trials
`
`
`
`
`
`The occurrence of adverse reactions was also evaluated in a larger pool of patients with type 2 diabetes
`
`
`
`
`
`participating in 7 placebo- and active-controlled glycemic control trials [see Clinical Studies (14)] including
`
`
`
`
`
`
`
`two trials in Japanese patients evaluating the use of OZEMPIC as monotherapy and add-on therapy to oral
`
`medications or insulin. In this pool, a total of 3150 patients with type 2 diabetes were treated with OZEMPIC
`
`
`for a mean duration of 44.9 weeks. Across the treatment arms, the mean age of patients was 57 years, 3.2%
`
`
`
`
`
`were 75 years or older and 57% were male. In these trials, 60% were White, 6% were Black or African
`
`
`
`
`
`
`American, and 31% were Asian; 16% identified as Hispanic or Latino ethnicity. At baseline, patients had type 2
`diabetes for an average of 8.2 years and had a mean HbA1c of 8.2%. At baseline, 7.8% of the population
`
`
`
`
`reported retinopathy. Baseline estimated renal function was normal (eGFR ≥90 mL/min/1.73m2) in 63.1%,
`
`
`
`mildly impaired (eGFR 60 to 90 mL/min/1.73m2) in 34.3%, and moderately impaired (eGFR 30 to 60
`
`
`
`mL/min/1.73m2) in 2.5% of the patients.
`
`
`
`
`
`Common Adverse Reactions
`
` Table 1 shows common adverse reactions, excluding hypoglycemia, associated with the use of OZEMPIC in the
`
`
`
`
`
`
` pool of placebo-controlled trials. These adverse reactions occurred more commonly on OZEMPIC than on
` placebo, and occurred in at least 5% of patients treated with OZEMPIC.
`
`
`
`
`
` Table 1. Adverse Reactions in Placebo-Controlled Trials Reported in ≥5% of OZEMPIC-Treated
`
`
` Patients with Type 2 Diabetes Mellitus
`
` Adverse Reaction
` Placebo
`
`
` (N=262)
`
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
`
`
` OZEMPIC 0.5 mg
` (N=260)
`
`
`
`
`
`
`
`
`
` OZEMPIC 1 mg
` (N=261)
`
`
`
`
`

`

`
` %
`
` 6.1
`
`2.3
`
` 1.9
`
` 4.6
`
` 1.5
`
` %
`
`
` 15.8
`
`5.0
`
` 8.5
`
` 7.3
`
` 5.0
`
` %
`
`
` 20.3
`
`9.2
`
` 8.8
`
` 5.7
`
` 3.1
`
`
`
`
`
` Nausea
`
`
` Vomiting
`
` Diarrhea
` Abdominal pain
`
`
` Constipation
`
` In the pool of placebo- and active-controlled trials and in the 2-year cardiovascular outcomes trial, the types and
`
`
`
`
`
` frequency of common adverse reactions, excluding hypoglycemia, were similar to those listed in Table 1.
`
`
`
`Gastrointestinal Adverse Reactions
`
`
`In the pool of placebo-controlled trials, gastrointestinal adverse reactions occurred more frequently among
`
`
`
`
`patients receiving OZEMPIC than placebo (placebo 15.3%, OZEMPIC 0.5 mg 32.7%, OZEMPIC 1 mg 36.4%).
`
`
`
`The majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. More patients
`
`
`
`
`receiving OZEMPIC 0.5 mg (3.1%) and OZEMPIC 1 mg (3.8%) discontinued treatment due to gastrointestinal
`
`
`adverse reactions than patients receiving placebo (0.4%).
`
`
`
`
`
`In addition to the reactions in Table 1, the following gastrointestinal adverse reactions with a frequency of <5%
`
`
`
`
`
`
`
`were associated with OZEMPIC (frequencies listed, respectively, as: placebo; 0.5 mg; 1 mg): dyspepsia (1.9%,
`
`
`
`
`
`3.5%, 2.7%), eructation (0%, 2.7%, 1.1%), flatulence (0.8%, 0.4%, 1.5%), gastroesophageal reflux disease (0%,
`
`
`
`
`1.9%, 1.5%), and gastritis (0.8%, 0.8%, 0.4%).
`
`
`Other Adverse Reactions
`Hypoglycemia
`
`
`Table 2 summarizes the incidence of events related to hypoglycemia by various definitions in the placebo-
`
`
`controlled trials.
`
`
`Table 2. Hypoglycemia Adverse Reactions in Placebo-Controlled Trials In Patients with Type 2 Diabetes
`
`
`
`Mellitus
`
`
`
`
` OZEMPIC 0.5 mg
`
`
`
`
`
` OZEMPIC 1 mg
`
`
`
`
`
` Placebo
`
`
`
` Monotherapy
`
`
` (30 weeks)
`
`
` Severe†
` Documented symptomatic
` (≤70 mg/dL glucose
`
`
`
` threshold)
` Severe† or Blood Glucose
`
`
` Confirmed Symptomatic
`
` (≤56 mg/dL glucose
`
`
`
` threshold)
`
` Add-on to Basal Insulin with or without Metformin
`
`
`
` N=132
` (30 weeks)
`
`
`
` Severe†
` 0%
` 15.2%
` Documented symptomatic
`
` (≤70 mg/dL glucose
`
`
`
` threshold)
` Severe† or Blood Glucose
`
`
` Confirmed Symptomatic
`
` (≤56 mg/dL glucose
`
`
`
` threshold)
`
`
`
`
`
`
` N=129
`
` 0%
`
` 0%
`
`
`
` 1.6%
`
`
`
`
`
`
`
` 5.3%
`
`
`
` N=127
`
` 0%
` 1.6%
`
`
`
`
` 0%
`
`
`
` N=132
`
` 0%
` 16.7%
`
`
`
`
`
` 8.3%
`
`
` N=130
`
` 0%
` 3.8%
`
`
`
`
` 0%
`
`
` N=131
`
` 1.5%
` 29.8%
`
`
`
`
` 10.7%
`
`
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`Reference ID: 4416585Reference ID: 4525580
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`

`

`
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`
`
`
`
`† “Severe” hypoglycemia adverse reactions are episodes requiring the assistance of another person.
`
`
`
`
` Hypoglycemia was more frequent when OZEMPIC was used in combination with a sulfonylurea [see Warnings
`
`
`
`
`
`
`
`
` and Precautions (5.5) and Clinical Studies (14)]. Severe hypoglycemia occurred in 0.8% and 1.2% of patients
`
` when OZEMPIC 0.5 mg and 1 mg, respectively, was co-administered with a sulfonylurea. Documented
`
`
` symptomatic hypoglycemia occurred in 17.3% and 24.4% of patients when OZEMPIC 0.5 mg and 1 mg,
`
`
`
` respectively, was co-administered with a sulfonylurea. Severe or blood glucose confirmed symptomatic
`
` hypoglycemia occurred in 6.5% and 10.4% of patients when OZEMPIC 0.5 mg and 1 mg, respectively, was co-
`
`
` administered with a sulfonylurea.
`
`
`
`Injection Site Reactions
`In placebo-controlled trials, injection site reactions (e.g., injection-site discomfort, erythema) were reported in
`
`
`0.2% of OZEMPIC-treated patients.
`
`
`
`Increases in Amylase and Lipase
`
`
`In placebo-controlled trials, patients exposed to OZEMPIC had a mean increase from baseline in amylase of
`
`
`
`
`13% and lipase of 22%. These changes were not observed in placebo-treated patients.
`
`
`
`
`Cholelithiasis
`
`
`
`
`
`In placebo-controlled trials, cholelithiasis was reported in 1.5% and 0.4% of patients-treated with OZEMPIC
`
`
`
`
`
`0.5 mg and 1 mg, respectively. Cholelithiasis was not reported in placebo-treated patients.
`
`
`
`Increases in Heart Rate
`In placebo-controlled trials, OZEMPIC 0.5 mg and 1 mg resulted in a mean increase in heart rate of 2 to 3 beats
`
`
`
`
`
`
`
`per minute. There was a mean decrease in heart rate of 0.3 beats per minute in placebo-treated patients.
`
`
`
`
`Fatigue, Dysgeusia and Dizziness
`
`Other adverse reactions with a frequency of >0.4% were associated with OZEMPIC include fatigue, dysgeusia
`
`
`
`
`
`
`and dizziness.
`
`
`Immunogenicity
`6.2
`
`
`Consistent with the potentially immunogenic properties of protein and peptide pharmaceuticals, patients treated
`with OZEMPIC may develop anti-semaglutide antibodies. The detection of antibody formation is highly
`
`
`
`
`dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody
`
`
`
`
`(including neutralizing antibody) positivity in an assay may be influenced by several factors including assay
`
`methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease.
`
`
`For these reasons, the incidence of antibodies to semaglutide in the studies described below cannot be directly
`
`
`
`
`
`
`compared with the incidence of antibodies in other studies or to other products.
`
`
`
`Across the placebo- and active-controlled glycemic control trials, 32 (1.0%) OZEMPIC-treated patients
`
`
`
`
`developed anti-drug antibodies (ADAs) to the active ingredient in OZEMPIC (i.e., semaglutide). Of the 32
`
`
`
`
`
`semaglutide-treated patients that developed semaglutide ADAs, 19 patients (0.6% of the overall population)
`
`
`developed antibodies cross-reacting with native GLP-1. The in vitro neutralizing activity of the antibodies is
`
`
`
`
`
`uncertain at this time.
`
`
`DRUG INTERACTIONS
`7
`
`
`7.1
`Concomitant Use with an Insulin Secretagogue (e.g., Sulfonylurea) or with Insulin
`
`
`
`The risk of hypoglycemia is increased when OZEMPIC is used in combination with insulin secretagogues (e.g.,
`
`sulfonylureas) or insulin. The risk of hypoglycemia may be lowered by a reduction in the dose of sulfonylurea
`
`
`
`(or other concomitantly administered insulin secretagogues) or insulin [see Warnings and Precautions (5.5)].
`
`
`
`
`
`7.2 Oral Medications
`
`
`
`
`
`Reference ID: 4416585Reference ID: 4525580
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`

`

`
`
`
`
`OZEMPIC causes a delay of gastric emptying, and thereby has the potential to impact the absorption of
`
`
`
`
`
`
`concomitantly administered oral medications. In clinical pharmacology trials, semaglutide did not affect the
`
`absorption of orally administered medications to any clinically relevant degree [see Clinical Pharmacology
`
`(12.3)]. Nonetheless, caution should be exercised when oral medications are concomitantly administered with
`
` OZEMPIC.
`
`
`
`USE IN SPECIFIC POPULATIONS
`8
`
`
`Pregnancy
`8.1
`
`Risk Summary
`There are limited data with semaglutide use in pregnant women to inform a drug-associated risk for adverse
`
`
`developmental outcomes. There are clinical considerations regarding the risks of poorly controlled diabetes in
`
`
`
`pregnancy (see Clinical Considerations). Based on animal reproduction studies, there may be potential risks to
`
`
`the fetus from exposure to semaglutide during pregnancy. OZEMPIC should be used during pregnancy only if
`
`the potential benefit justifies the potential risk to the fetus.
`
`
`In pregnant rats administered semaglutide during organogenesis, embryofetal mortality, structural abnormalities
`
`
`
`
`and alterations to growth occurred at maternal exposures below the maximum recommended human dose
`
`
`
`
`
`
`
`
`(MRHD) based on AUC. In rabbits and cynomolgus monkeys administered semaglutide during organogenesis,
`
`
`
`
`early pregnancy losses and structural abnormalities were observed at below the MRHD (rabbit) and ≥5-fold the
`
`
`
`
`
`MRHD (monkey). These findings coincided with a marked maternal body weight loss in both animal species
`
`
`(see Data).
`
`
`The estimated background risk of major birth defects is 6–10% in women with pre-gestational diabetes with an
`
`HbA1c >7 and has been reported to be as high as 20–25% in women with a HbA1c >10. In the U.S. general
`
`
`
`
`
`
`population, the estimated background risk of major birth defects and miscarriage in clinically recognized
`pregnancies is 2-4% and 15-20%, respectively.
`
`
`
`Clinical Considerations
`
`Disease associated maternal and fetal risk
`
`Poorly controlled diabetes during pregnancy increases the maternal risk for diabetic ketoacidosis, pre­
`
`
`
`eclampsia, spontaneous abortions, preterm delivery, stillbirth and delivery complications. Poorly controlled
`
`
`diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity.
`
`
`Data
`
`Animal Data
`In a combined fertility and embryofetal development study in rats, subcutaneous doses of 0.01, 0.03 and 0.09
`
`mg/kg/day (0.1-, 0.4-, and 1.1-fold the MRHD) were administered to males for 4 weeks prior to and throughout
`mating and to females for 2 weeks prior to mating, and throughout organogenesis to Gestation Day 17. In
`
`
`parental animals, pharmacologically mediated reductions in body weight gain and food consumption were
`
`
`
`
`observed at all dose levels. In the offspring, reduced growth and fetuses with visceral (heart blood vessels) and
`
`
`
`
`skeletal (cranial bones, vertebra, ribs) abnormalities were observed at the human exposure.
`
`
`In an embryofetal development study in pregnant rabbits, subcutaneous doses of 0.0010, 0.0025 or 0.0075
`
`
`mg/kg/day (0.03-, 0.3-, and 2.3-fold the MRHD) were administered throughout organogenesis from Gestation
`
`
`Day 6 to 19. Pharmacologically mediated reductions in maternal body weight gain and food consumption were
`
`
`
`observed at all dose levels. Early pregnancy losses and increased incidences of minor visceral (kidney, liver)
`
`
`and skeletal (sternebra) fetal abnormalities were observed at ≥0.0025 mg/kg/day, at clinically relevant
`
`exposures.
`
`
`
`
`In an embryofetal development study in pregnant cynomolgus monkeys, subcutaneous doses of 0.015, 0.075,
`
`
`and 0.15 mg/kg twice weekly (1.0-, 5.2-, and 14.9-fold the MRHD) were administered throughout
`organogenesis, from Gestation Day 16 to 50. Pharmacologically mediated, marked initial maternal body weight
`
`
`
`Reference ID: 4416585Reference ID: 4525580
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`

`

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`
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` loss and reductions in body weight gain and food