It’s a drug that has dominated headlines, first as a medication for type 2 diabetes, then as a weight loss aid. Now it appears that semaglutide — often called by its brand names Ozempic or Wegovy — may have benefits in numerous areas of health care, from addiction to dementia.
Diabetes
Semaglutide, which can be taken as a tablet or via injection, mimics a hormone produced in the body called GLP-1 – a substance released in the gut when we eat.
GLP-1, and therefore also semaglutide, slows the rate at which food is digested in the stomach, and acts on the brain to reduce appetite. Importantly, it also causes an increase in the production of insulin – a hormone that plays an important role in regulating blood sugar levels.
Tons of studies Showed regular dosing with semaglutide results in significant improvements in blood sugar control in people with type 2 diabetes – although some trials were funded by the manufacturer of the drugNovo Nordisk.
As a result, drugs such as semaglutide are available on the NHS for people with type 2 diabetes and is considered a valuable tool.
Weight loss
A key finding from studies looking at semaglutide for type 2 diabetes was that the drug was associated with a reduction in body weight. As a result, semaglutide found a new market as a slimming aid in people without type 2 diabetes, nicknamed the “skinny prick”.
Research published in the New England Journal of Medicineinvolving 1,961 overweight obese adults without type 2 diabetes found that while those who received a placebo in addition to lifestyle interventions lost an average of 2.6 kg over the course of the 68-week study, those who received ‘ received a weekly injection with semaglutide along with lifestyle interventions, lost 15.3kg on average.
Experts say drugs like semaglutide are an important tool for managing the obesity crisis, but many also warns that such drugs don’t tackle the cause of the problem.
Currently, GLP-1 mimics, including semaglutide, are available to some groups on the NHS, although prescriptions can only be given for a maximum of two years due to a lack of long-term data.
But results of a trial known as the Select study showed that continued treatment for four years was not only safe but also associated with sustained weight loss.
“It is very encouraging that continued treatment for four years or so is effective in helping people lose weight at a clinically significant level of 10% on average,” says Tricia Tan, professor of metabolic medicine and endocrinology at Imperial College in London.
“Previously, the only proven and effective long-term treatment for obesity was weight loss surgery where we have evidence that surgery is able to provide long-term weight loss for 20 years or so. This trial helps support the idea that semaglutide is effective at least in the medium term. “
But semaglutide is not without side effectswith some dropping out of the study because they felt ill or experienced diarrhoea.
Heart attacks
The Select study previously suggested a weekly dose of semaglutide can reduce the risk of heart attack, stroke and death from cardiovascular causes in overweight or obese adults with pre-existing cardiovascular disease by approximately 20%.
However analysis of the research – yet to be published – revealed that the proportional reduction in such events applies regardless of the participants’ starting weight.
The results have led some experts to suggest that semaglutide should be routinely prescribed to treat cardiovascular disease. However, others say there are still unknowns – including the mechanism involved – that could limit such applications.
Dementia
Studies suggested the rate of dementia is lower in people with type 2 diabetes who take GLP analogues, such as semaglutide, compared to those who receive a placebo.
As a result, researchers teamed up with manufacturers to carry out trials to investigate whether the drug can help people with early Alzheimer’s disease.
“In our study, we give it to people who don’t have dementia but who are at risk by having high levels of the Alzheimer’s disease protein amyloid in the brain,” said Dr Ivan Koychev from the University of Oxford. .
When it comes to dementia, there are several mechanisms by which semaglutide may benefit, from reducing inflammation in the brain to reducing the accumulation of proteins associated with Alzheimer’s disease.
“This class of drugs is [also] known to reduce the risk of vascular events and therefore the effect on dementia may be by reducing the incidence of large strokes or reducing the likelihood of smaller blood vessel scarring,” Koychev added.
While Koychev is optimistic, it’s worth noting that many highly promising dementia drugs have fallen by the wayside as trials have progressed.
Addiction
This is a promising area for semaglutide, as the drug appears to dampen not only the reward system associated with food, but also drugs.
Indeed, research has previously suggested that GLP-1 analogs are associated with reduced alcohol consumption and a more likely to smoke abstinence Studies in mice and rats have also suggested that the medication alters addictive behavior, reduce drug seeking and consumption.
Although large-scale, robust studies in humans are needed, it is unclear whether such drugs generally dampen reward signals in the brain – raising concerns about their use in people with depression.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is thought to affect 8-13% of women of reproductive ageand can cause irregular periods, hormone imbalances and infertility.
Although semaglutide is thought to help people with PCOS because of its effects on weight loss, experts have suggested that other mechanisms may also be at play.
Trials are now underway to investigate whether semaglutide can help boost the rate of ovulation among those with PCOS – an outcome that can also improve fertility – as well as the impact on levels of hormones, including testosterone.
Cancer
Although there has been concern that GLP-1 mimetics may increase the risk of thyroid and pancreatic cancer, recent research has sow uncertainty on these concerns.
Studies have even suggested that such drugs can help reduce the risk of certain cancers, with research published last year suggesting they are associated with reduced risk of colorectal cancer in people with type 2 diabetes both with and without extra body weight.
With more pronounced effects found in overweight and obese patients, the authors say the results may be due, at least in part, to such drugs helping people lose weight.
Prof Simon Cork from Anglia Ruskin University said the theory made sense.
“Obesity is known to increase the risk of at least 13 different types of cancer, so reducing body weight will almost certainly reduce the risk for those particular cancers,” he said.
