It’s a drug that’s dominating headlines, first as a cure for type 2 diabetes, then as a weight-loss aid. Now it appears that semaglutide – often referred to by the brand names Ozempic or Wegovy – could provide benefits in numerous areas of healthcare, from addiction to dementia.
Diabetes
Semaglutide, which can be taken as a tablet or by injection, mimics a hormone produced in the body called GLP-1 – a substance released in the intestines when we eat.
GLP-1, and therefore semaglutide, slows the rate at which food is digested in the stomach and acts on the brain to reduce appetite. Crucially, it also causes an increase in the production of insulin – a hormone that plays an important role in regulating blood sugar levels.
Numerous studies have shown regular dosing with semaglutide results in significant improvements in blood sugar control in people with type 2 diabetes – though some studies are funded by the drug’s makerNovo Nordisk.
As a result, medications such as semaglutide are available on the NHS for people with type 2 diabetes and are considered a valuable resource.
Weight loss
A key finding from studies of semaglutide for type 2 diabetes was that the drug is associated with a reduction in body weight. As a result, semaglutide has found a new market as a weight-loss drug in people without type 2 diabetes, nicknamed the “skinny jab.”
Research published in the New England Journal of Medicineinvolving 1,961 obese adults without type 2 diabetes, found that while those given 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 a weekly injection of semaglutide in addition to lifestyle interventions lost Average 15.3 kg.
Experts say drugs like semaglutide are an important tool in managing the obesity crisis, but many also warn that such drugs don’t address the root of the problem.
Currently, GLP-1 mimics, including semaglutide, are available to some groups within the NHS, although prescriptions can only be given for up to two years due to a lack of long-term data.
However, results of a study known as the Select study have shown that continued treatment for four years is not only safe, but also associated with sustained weight loss.
“It is very encouraging that continued treatment for about four years is effective in helping people lose weight at a clinically significant level of 10% on average,” said Tricia Tan, professor of metabolic medicine and endocrinology at Imperial College 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 achieve long-term weight loss for about twenty years. This trial helps support the idea that semaglutide is effective at least in the medium term.”
But semaglutide is not without side effects; some dropped out of the study because they felt sick or developed diarrhea.
Heart attacks
The Select study previously suggested a weekly dose of semaglutide could reduce the risk of heart attack, stroke and death from cardiovascular causes by about 20% in overweight or obese adults with pre-existing cardiovascular disease.
However, analysis of the study – which has yet to be published – has shown that the proportional reduction in such events applies regardless of the starting weight of the participants.
The results have led some experts to suggest that semaglutide should be prescribed routinely for the treatment of cardiovascular disease. However, others say there are still unknowns – including the mechanism involved – that could limit such applications.
Dementia
Studies have 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 have collaborated with manufacturers conduct studies to investigate whether the drug can help people with early Alzheimer’s disease.
“In our study we are giving it to people who do not have dementia but are at risk from high levels of the Alzheimer’s disease protein amyloid in the brain,” says Dr. Ivan Koychev of the University of Oxford.
When it comes to dementia, several mechanisms have been suggested by which semaglutide could have benefits, from reducing inflammation in the brain to reducing the buildup of proteins. associated with Alzheimer’s disease.
“This class of drugs is (also) known to reduce the risk of vascular events and so the effect on dementia may be to reduce the incidence of major strokes or reduce the likelihood of smaller scars in the blood vessels,” Koychev added.
While Koychev is optimistic, it’s worth noting that many promising anti-dementia drugs have fallen by the wayside as trials progress.
Addiction
This is a promising area for semaglutide, as the drug appears to dampen the reward system associated with not only food, but also drugs.
Research has previously suggested that GLP-1 analogs are associated with reduced diabetes alcohol use and a greater chance of smoking abstinence. Studies in mice and rats have also suggested that the drugs alter addictive behavior. reducing the search for drugs and consumption.
However large-scale, robust studies in humans are needed, while it is unclear whether such drugs dampen reward signaling generally in the brain, raising concerns about their use in people with depression.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is probably affects 8-13% of women of childbearing ageand can cause irregular periods, hormonal imbalances and infertility.
While it is thought that semaglutide could help people with PCOS due to its effects on weight loss, experts have suggested that other mechanisms may also be at play.
Studies are now underway to investigate whether semaglutide could increase ovulation rates in people with PCOS – a result that could also improve fertility – and whether this could help too. influence on levels of hormones, including testosterone.
Cancer
Although there are concerns that GLP-1 mimics could increase the risk of thyroid and pancreatic cancer, recent research has sowing doubt on these concerns.
Studies have even suggested that such medications may help reduce the risk of certain cancers. with research published last year showing they are associated with a reduced risk of colorectal cancer in people with type 2 diabetes, both with and without extra body weight.
Because more pronounced effects have been found in overweight and obese patients, the authors say the results may be due, at least in part, to the fact that such drugs help people lose weight.
Professor Simon Cork from Anglia Ruskin University said the theory makes sense.
“Obesity is known to increase the risk of at least thirteen different types of cancer, so reducing body weight would almost certainly reduce the risk of those specific cancers,” he said.