November 15, 2024
The weight-loss jab Wegovy made its debut on June 4 2021. It was the first new weight-loss drug to be approved by the US Food and Drug Administration since 2014.
There has been a lot of excitement since the launch. Not only is the drug extremely effective (people lose about 15 percent of their body weight in a year), it also appears to have many benefits beyond just weight loss.
It's worth noting that the drug (generic name: semaglutide) was first used to treat diabetes, and indeed is still a blockbuster diabetes drug. So that's two benefits already. Let's look at some of the other potential benefits. Here are eight (and the list isn't exhaustive).
Knee cartilage is not designed for high stress loads. People who are overweight or obese are at a higher risk of developing osteoarthritis because of the extra stress on their knee joints, with many people eventually requiring knee-replacement surgery.
A recent study, published in the New England Journal of Medicine, followed a group of 407 obese people with knee osteoarthritis for 68 weeks. Some of the group received semaglutide and some a placebo. Both groups also received counselling on physical activity and a reduced-calorie diet.
The group that received semaglutide (as opposed to a placebo), reported a huge decrease in pain from 71 to 42 points on a standard pain scale (zero to 100, where a larger number equals more pain). They also reported greater mobility. The same was not experienced in the placebo group.
The reasons for the improvement are probably due to the rapid weight loss combined with the anti-inflammatory properties of semaglutide. It's not clear, though, if semaglutide would have the same effect on people with knee osteoarthritis who aren't obese.
About one in four people, globally, has fatty liver disease – a long-lasting liver condition that can progresses to cirrhosis (liver scarring). In the late stages, it can be fatal.
Initial clinical trial data has shown very promising results with semaglutide, with a significant reduction in liver fat of 31 percent. In another clinical study, fatty liver was completely resolved in a third of patients after just 24 weeks.
The next question is whether semaglutide can reverse the more severe forms of fatty liver disease, where scarring has begun. Several studies are underway to test this.
In studies using brain cells (neurons) in a Petri dish and in mouse models of Parkinson's, semaglutide has been shown to have beneficial effects on several "pathological hallmarks" of the neurological disease.
There is even a hint that semaglutide may work at slowing the worsening of Parkinson's in humans. A French study, published earlier this year, using a similar drug (called a GLP-1 receptor agonist), found that the motor skills of people with early-stage Parkinson's given the treatment showed almost no worsening of symptoms compared with people given a placebo.
We will have to wait for the results of current trials to see if semaglutide has a similar effect.
Semaglutide may provide some protection in people with Alzheimer's as many people with the condition also have diabetes, suggesting that high glucose is involved.
In mouse studies and human organoid models of Alzheimer's, semaglutide has been shown to reduce deposits of tau and amyloid (the two proteins that accumulate in the brains of people with Alzheimer's). And a recent "meta-analysis" of seven clinical trials of people with type 2 diabetes but undiagnosed Alzheimer's, showed that over three years, 40 percent-70 percent of patients on semaglutide had a lower risk of an Alzheimer's diagnosis.
Given that there are currently no cures for Alzheimer's disease, prevention seems to be the best option, especially for those at higher risk of the disease (that is, those with diabetes and obesity).
Chronic kidney disease is irreversible, so managing the cause is important. The leading cause of kidney failure is diabetes, where high glucose levels damage the small blood vessels in the kidneys.
Two recent randomised clinical trials studying semaglutide for three to five years were completed in 2024 and showed that a biomarker of kidney damage (microalbumin) was lower in patients taking semaglutide. Patients in the semaglutide group also had a lower risk of developing kidney failure (24 percent) and a lower risk of death (20 percent) over the study period.
The GLP-1 system that semaglutide relies on for its effects is known to be involved in the neurobiology of addiction. Indeed, in studies of mice fed alcohol, semaglutide reduced binge drinking in the rodents.
And preliminary data in people with alcohol use disorder given semaglutide or a placebo, found that those on semaglutide had "greater reductions in drinking quantity and heavy drinking" compared with those in the placebo group.
And a new study from Sweden showed that people with alcohol dependence were much less likely to be hospitalised due to physical illness when using semaglutide.
These studies suggest semaglutide may provide an alternative treatment option for people with addiction problems.
As glucose-lowering drugs such as semaglutide lower a person's cardiovascular risk by 14 percent in people with diabetes, the use of semaglutide has been studied in a range of heart disease conditions.
A clinical study showed that patients with existing cardiovascular disease who are obese or overweight, but without diabetes, taking semaglutide for up to four years showed lower rates of heart attack and stroke over a three and a half year period.
Also, in a study of over 4,000 people, weekly semaglutide significantly reduced heart failure, clogged arteries and death from any cause, compared with a placebo. As a result of these findings, the US Food and Drug Administration approved semaglutide to help prevent life-threatening cardiovascular events in people with existing heart disease who are either overweight or obese.
Because of semaglutide's wider protective properties, such as its anti-inflammatory features, it has been studied in various lung disorders.
In a mouse model of acute lung injury, where unregulated inflammation occurs leading to high death rates, semaglutide reduced lung swelling, inflammation, white blood cell infiltration and cell death.
A large review of 28 clinical studies showed that semaglutide treatment led to an 18 percent reduction in the development of respiratory diseases.
A clinical trial is underway to study the protection offered in patients with advanced interstitial lung disease, which comprises a large number of lung disorders (over 200) where there is damage to the tissues between the small air sacs in the lungs (alveoli) and the blood vessels around them, causing inflammation and scarring (fibrosis).
Vinood B. Patel, Professor in Clinical Biochemistry, University of Westminster
This article is republished from The Conversation under a Creative Commons license. Read the original article.
