Endocrinology in the News: Semaglutide for Weight Loss

Last week Novo Nordisk published the results of their trial of semaglutide (marketed as Ozempic for type 2 diabetes) for weight loss in overweight and obese patients without diabetes.  I have been waiting for these results for a long time.  Today I will share why.

Semaglutide is part of a class of medications called GLP-1 analogues.  From their advent to the market GLP-1 analogues have shown real promise in treating obesity. Unlike many older medications for type 2 diabetes, GLP-1 analogues lead to weight loss rather than weight gain.  Almost immediately endocrinologist began prescribing them off-label* for weight loss.  

In 2014 liraglutide (Victoza for diabetes) was approved for weight loss as Saxenda.  But shortly after that semaglutide was approved for diabetes (as Ozempic, you’ve seen the commericals…) and the data on weight loss in the diabetes trials was impressive.  Plus, Saxenda is a daily injection and semaglutide is a once weekly injection–a much more attractive regimen for patients.

The data released last week was impressive.  The trial of more than 1900 people showed a weight loss of 15% in the group receiving semaglutide.  This is significantly better than trials of semaglutide’s closest competitors Saxenda and Qsymia.  Those of us using Ozempic off-label for weight loss knew we were seeing excellent weight loss in our patients, but seeing that born out in a clinical trial is helpful.

So, what’s the catch?

There are two main issues I am anticipating.  The first is access.  GLP-1 analogues are expensive, often upwards of $1000 per month. Insurance companies often tighten up their approval process after news like this.  After Saxenda (liraglutide) was approved, the insurance approval process for Victoza (also liraglutide) got tough.  Many insurance companies only cover obesity medications if the patient’s employer opts into obesity coverage.  Sometimes insurance administrators in employers’ HR departments don’t even realize.

The second issue is tolerability.  All weight loss medications have side effects.  The most common side effect of GLP-1 analogues is nausea.  The dose used in the semaglutide trial is more than twice the maximum dose of semaglutide used to treat type 2 diabetes.  Based on my experience prescribing lower doses of semaglutide, at this higher dose there will be a LOT of nausea.

All that said, semaglutide will continue to be an important tool in my arsenal for treating overweight and obesity.  And this data should help expand its availability and use to more patients, which would definitely be a great thing!

*Once a medication is approved by the FDA for any indication, physicians can prescribe the drug for any purpose they see fit.  This practice, off-label drug use, is a very common practice.  For example, another common diabetes medication metformin is used in non-diabetics to treat PCOS, overweight and to prevent cancer–all uses for which it has been studied, but not approved indications.

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