I have had quite a few patients ask me recently if I would support them being prescribed semaglutide. You may not be familiar with the name, but you may well have heard of it as a weight loss wonder drug. The reason I thought I would write about it today is that the FDA (US food and drug administration – similar to our own NICE body in the UK) have approved it for use in overweight or obese adults with cardiovascular disease.
Firstly, what is semaglutide? It comes from a family of drugs called GLP-1 agonists. An agonist is something that causes a physiological effect when combined with a receptor. GLP-1 stands for glucagon-like peptide-1. GLP-1 is a hormone released into the gut when you eat. It caused a rise in insulin, and therefore a reduction in glucose level. It also has effects in the brain, where it causes a feeling of fullness and satiety. A GLP-1 agonist therefore is a medication which binds with a receptor in the body and has the same effect as eating – raised insulin and feeling full – without a person having consumed any food. Clever.
There are two forms – Ozempic and Wegovy, which are essentially the same drug but in different doses – one is intended for diabetic patients only.
So what evidence have the FDA reviewed? The SELECT trial randomly assigned 17,604 patients with cardiovascular disease and body mass index ≥ 27 to weekly semaglutide or placebo. None of the patients had diabetes, although two thirds met prediabetes criteria.
Often heart trials look for outcomes called MACE – ‘Major adverse cardiovascular events’ which includes death due to a cardiovascular cause, non-fatal heart attack, or non-fatal stroke. In this trial, there was a statistically significant reduction in MACE of 20% in the group treated with semaglutide compared to placebo. In addition to this, death from any cause was reduced by 19%.
These are pretty staggering results. The weight loss numbers were similarly impressive – the treatment group lost 9.4% of their body weight compared to 0.88% in the placebo group. All drugs may of course have side effects, and indeed this was the case here with 16.6% of patients having them – mostly gut upset. Interestingly though 8.2% of patients taking placebo had side effects – this just shows the power of the mind – if you think you are likely to experience a side effect, you are much more likely to do so.
The drug is intended to be used in conjunction with a low calorie diet and increased physical exercise, which is also what our UK guidelines say.
Sounds too good to be true? There is a catch. Such has been the success of the drug, that there is a worldwide shortage. I am very happy to recommend it for patients but GPs simply can’t get hold of it. How long this will last is anybody’s guess, but it has been like this for over a year now.
Let me take you back to the start though. Semaglutide promotes the feeling of satiety – it helps people eat less. Being ‘over-caloried’ compared to the metabolic needs of our bodies is one of the biggest health issues the world faces. Calorie counting I think is actually rather hard – I’ve done it here and there to ‘count my macros’. How much protein, fat and carbohydrate am I eating? However there are many free apps available to help. I use ‘my fitness pall’ (which has a free and paid version). We will each vary in our needs for these macros, and I haven’t the room to go into it here, but please just consider this – if you are someone who feels they would benefit from semaglutide, what steps could you take now whilst waiting for it to be available? It needs to be prescribed with a low calorie diet and exercise anyway, so why not start that now? Find an app you like, and do the maths this week – calories in vs calories used. It will put you in a great position to start.