Media release

From: European Congress on Obesity

Semaglutide shown to be effective for weight loss in multicentre, one-year real-world study

Embargo 2301H UK time Friday 19 May

New research presented at this year’s European Congress on Obesity (ECO2023, Dublin, 17-20 May) shows that the obesity drug semaglutide is effective for weight loss in a multicentre, 1-year-long real-world study. The study is by Dr Andres Acosta and Dr Wissam Ghusn, Precision Medicine for Obesity Program at the Mayo Clinic, Rochester, MN, USA and colleagues.

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is the most recently FDA-approved anti-obesity medication. It has shown significant weight loss outcomes in multiple long-term randomised clinical trials and short-term real-world studies. However, little is known about the weight loss and metabolic parameters outcomes in mid-term real-world studies. In this study, the authors assessed weight loss outcomes associated with semaglutide in patients with overweight and obesity with and without type 2 diabetes (T2DM) at 1 year follow-up.

They performed a retrospective, multicentre (Mayo Clinic Hospitals: Minnesota, Arizona, and Florida) data collection on the use of semaglutide for the treatment of obesity. They included patients with a body mass index (BMI) ≥27 kg/m2 (overweight and all higher BMI categories) who were prescribed weekly semaglutide subcutaneous injections (doses 0.25, 0.5, 1, 1.7, 2, 2.4mg; however most were on the higher dose 2.4mg). They excluded patients taking other medications for obesity, those with a history of obesity surgery, those with cancer, and those who were pregnant.

The primary end point was total body weight loss percentage (TBWL%) at 1 year. Secondary end points included proportion of patients achieving ≥5%, ≥10%, ≥15%, and ≥20% TBWL%, change in metabolic and cardiovascular parameters (blood pressure, HbA1c [glycated haemoglobin, a measure of blood sugar control], fasting glucose and blood fats), TBWL% of patients with and without T2DM, and frequency of side effects during the first year of therapy.

A total of 305 patients were included in the analysis (73% female, mean age 49 years, 92% white, mean BMI 41, 26% with T2DM) . Baseline characteristics and weight management visit details are presented in Table 1 full abstract. In the entire cohort, the mean TBWL% was 13.4% at 1 year (for the 110 patients who had weight data at 1 year). Patients with T2DM had a lower TBWL% of 10.1% for the 45 of 110 patients with data at 1 year, compared to those without T2DM of 16.7% for the 65 of 110 patients with data at 1 year.

The percentage of patients that lost more than 5% of their body weight was 82%, more than 10% was 65%, more than 15% was 41%, and more than 20% was 21% at 1 year. Semaglutide treatment also significantly decreased systolic and diastolic blood pressure by 6.8/2.5 mmHg; total cholesterol by 10.2 mg/dL; LDL of 5.1 mg/dL; and triglycerides of 17.6 mg/dL. Half of the patients experienced side effects related to the medication use (154/305) with the most reported being nausea (38%) and diarrhoea (9%) (Figure 1D). The side effects were mostly mild not affecting the quality of life but in 16 cases they resulted in stopping the medication.

The authors conclude: “Semaglutide was associated significant weight loss and metabolic parameters improvement at 1 year in a multi-site real-world study, demonstrating its effectiveness in the treatment of obesity, in patients with and without T2DM.”

The Mayo team are preparing several other manuscripts relating to semaglutide, including weight outcomes in patients who had weight recurrence after bariatric surgery; weight loss outcomes in patients who were on other anti-obesity medications previously compared to those who were not.

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Study finds cardiovascular risk score improves after one year of semaglutide use in patients with overweight and obesity

Embargo 2301H UK time Friday 19 May

New research presented at this year’s European Congress on Obesity in Dublin, Ireland shows that patients treated with the obesity drug semaglutide have a decreased cardiovascular risk score after one year of use. The study is by Dr Andres Acosta and Dr Wissam Ghusn, Precision Medicine for Obesity Program at the Mayo Clinic, Rochester, MN, USA and colleagues.

Obesity is a major risk factor for the development of abnormal blood fat levels, type-2 diabetes mellitus (T2DM), high blood pressure, and obstructive sleep apnoea. These comorbidities are associated with an increased risk of cardiovascular disease (CVD) that represents the leading cause of death globally. Hence, there is a significant need to prevent CVD by targeting excess adiposity in patients with overweight or obesity.

Semaglutide is a recently approved anti-obesity medication whose cardiovascular impact in patients with and without T2DM is not well established. In this new research, the authors analysed the real-world effect of semaglutide use on the risk of CVD in patients with overweight or obesity.

They performed a multicentre retrospective study of 93 patients with a body-mass index (BMI) 27 kg/m2 or higher, age between 40-79 years, and no prior history of CVD. They collected baseline demographic, clinical, and blood fat data to calculate the 10-year atherosclerotic cardiovascular disease (10-year ASCVD) risk at baseline (i.e., before starting semaglutide) and 1 year after semaglutide initiation.

The score used is the 10-year ASCVD risk estimator created by the American College of Cardiology. The primary end point included calculating the difference in ASCVD score between baseline and after 1 year of starting semaglutide. Secondary outcomes included metabolic parameters and medication use.

Of the 93 participants, 69% were female, and the mean age was 55 years. Almost all (91%) were White. The mean BMI was 39.8kg/m2, on the borderline between class II and class III obesity.

There was a significant decrease in the 10-year ASCVD risk between baseline and 1 year: 7.64% vs 6.26%, a drop of 1.38%. The following parameters decreased significantly: blood pressure by 9.3/4.9 mmHg (for systolic and diastolic), total cholesterol by 9.5 mg/dL; LDL by 6.6 mg/dL, triglycerides by 20.0 mg/dL, fasting glucose by 23.0 mg/dL, and HbA1c (a measure of blood sugar control) by 0.72%. There was no significant change in use of blood pressure medications, statins, or aspirin between baseline and last follow-up. The total % body weight loss associated with semaglutide use at 12 months was 10.9% (across 41 patients for whom weight data was available at 12 months).

The authors conclude: “Use of semaglutide in patients with overweight or obesity is associated with a decrease in the 10-year ASCVD risk. Although modest after just one year of use, this decrease may translate into decreased cardiovascular morbidity and mortality risk over time with continuing weight loss. More studies, with larger sample sizes and longer follow-up periods, are needed to assess the cardiovascular outcomes of semaglutide.”

The authors are considering carrying out longer term studies to see if the effect of semaglutide on cardiovascular risk extends/changes over time.