A Good Look at Semaglutide for Obesity

We’ve been waiting for this. More than a year ago, Novo Nordisk announced very encouraging early results with semaglutide for obesity. It’s one thing to read a press release. But it means a lot more to read the detailed results in a top tier journal. Today, we have that publication.

Detailed Efficacy Data in Lancet

Late yesterday, Patrick O’Neil and colleagues published findings of a phase II dosing study for semaglutide. It was randomized and placebo-controlled. The study tested five different daily injection doses ranging from 0.05 to 0.4 mg. Also, the study included a group randomly assigned to treatment with liraglutide for obesity (3.0 mg daily). Everyone in the study received counselling on diet and physical activity.

The results match the encouraging words of the last year’s announcement from Novo Nordisk. Patients in the placebo group (plus diet and physical activity counseling) lost 2.3 percent of their starting body weight after 52 weeks. At the top two doses of semaglutide, patients lost 11 to 14 percent.

In addition, this publication provides detailed data on markers of obesity complications. Lipid profiles, blood pressure, and HbA1c all improved with doses of semaglutide of 0.2 mg or more

Superior Effectiveness vs Liragultide

But perhaps most impressive is detailed evidence that semaglutide might be more effective than liraglutide for obesity. The efficacy of the top two doses – in terms of mean weight loss – was significantly higher. On semaglutide, the average was 11 to 14 percent. For liraglutide it was 7.8 percent. At the top dose of 0.4 mg, roughly 40 percent of patients lost 20 percent or more of their initial weight. Only six percent lost that much on liraglutide.

In terms of safety, we don’t see a lot of new information here. Semaglutide is already approved in lower doses (weekly) for type 2 diabetes. The most common adverse events were GI, mainly nausea. But for a full accounting of the and efficacy in obesity, we’ll have to wait for phase 3 studies. They will be conducted with weekly dosing. So, the results will be clearer with a more complete data set.

Bottom Line: Encouragement

The bottom line here is encouragement. Semaglutide offers promise for becoming an obesity treatment with significantly more effectiveness than other drugs.

These are still early days for semaglutide. But this study suggests we’re seeing progress toward drugs that will have efficacy for obesity that matches bariatric surgery. Right now, what we have is more hope than reality. But it’s a reasonable hope.

Click here for the study in Lancet and here for a companion commentary.

Performance, photograph © Nicole Yeary / flickr

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August 17, 2018