ECO2024: Four Years of Semaglutide Heart and Weight Benefits

Doorway in San Marco, VeniceHow long? So many questions about advanced obesity medicines center on this line of inquiry. How long must I take these medicines, how long will their benefits last. Yesterday we learned at ECO2024 that four years of semaglutide offers impressive benefits for a person’s weight and heart health.

Nature Medicine published data on weight outcomes over four years and emerita professor Donna Ryan presented it today. She explained:

“Our long-term analysis of semaglutide establishes that clinically relevant weight loss can be sustained for up to 4 years in a geographically and racially diverse population of adults with overweight and obesity but not diabetes.

“This degree of weight loss in such a large and diverse population suggests that it may be possible to impact the public health burden of multiple obesity-related illnesses. While our trial focused on cardiovascular events, many other chronic diseases including several types of cancer, osteoarthritis, and anxiety and depression would benefit from effective weight management.”

10.2% Lower
Weight After Four Years

The durability of semaglutide efficacy in this four year study is the longest duration of treatment effect to date. By comparison, the effectiveness of tirzepatide is impressive. But the longest duration we have for a published study of that drug is less than half of the time that people were followed in this new study of semaglutide. What’s more, of course, is that we have data to show semaglutide reduces the number of heart attacks, strokes, and deaths that persons will have when they take it.

Cardiovascular Benefit

This heart health benefit is the subject of the second semaglutide study (the SELECT study) presented yesterday at ECO2024. Lead author professor John Deanfield was effusive. He told reporters:

“This fantastic drug really is a gamechanger. This study suggests that here are potentially alternative mechanisms for that improved cardiovascular outcome with semaglutide beyond weight loss. Quite clearly, something else is going on that benefits the cardiovascular system.”

Deanfield was also co-author on an abstract from ECO2024 that focused on patient safety in the SELECT study. Serious adverse events were actually lower in the semaglutide patients than in patients receiving placebo.

Arms-length observers clearly agree that we are witnessing a big advance. The U.S. Food and Drug Administration approved a new indication for semaglutide to treat people with obesity and heart disease based on this study. Then shortly after that, administrators of the Medicare program opened the door for Medicare drug plans to cover the drug for that purpose. For years, CMS had resisted ever covering a drug for obesity.

Those who have wondered if we are in the midst of inflated expectations for the benefits of advanced obesity medicines will be disappointed. But many people who need these improved options for obesity treatment are delighted. This is progress.

Click here for the study in Nature Medicine, and here for the study abstracts for the two other analyses of SELECT study data. For further perspective, click here, here, and here.

Doorway in San Marco, Venice, painting by Jose Villegas Y Cordero / Smithsonian American Art Museum

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May 14, 2024

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