Urology pearls: Research surrounding the medication Semaglutide

Shahar Madjar, MD

What if losing weight was as easy as taking a pill? Or as mindless as taking a weekly injection?

Researchers had previously shown that Semaglutide–a medication that has been marketed in the USA under the brand names Ozempic and Wegovy–was effective in patients with diabetes. Semaglutide improved their glycemic control (by reducing the level of glucose in their blood) and helped them lose weight. A new study was designed for a different group of patients–obese individuals without diabetes. The results of the study were published in the prestigious New England Journal of Medicine and have hit the news with a BANG!

How does Semaglutide work? In short: it improves the ways in which sugar is processed in our body. And in a longer, more scientific language: It acts like a hormone called glucagon-like-peptide-1. It increases the secretion of insulin which is the primary hormone that regulates the metabolism of sugar. This medication is long acting, and so, with no need for dieting, one weekly dose can make you look like a million dollars, or can it?

The researchers recruited 1961 participants. The participants were randomly assigned into two groups. One group received a weekly subcutaneous injection of Semaglutide while the other group was on placebo. Both groups received counseling regarding proper diet and exercise.

By week 68, the participants who were taking Semaglutide lost much more weight than those on placebo–15.3 kg (14.9% of their body weight) vs. only 2.6 kg (2.4% of their body weight). And many more participants in the Semaglutide group lost more than 5% of their starting weight (86.4% of the participants in the Semaglutide group vs. only 31.5% in the placebo group.

The participants in the Semaglutide group had greater improvement in their risk factors for heart disease and stroke and greater improvement in their physical functioning and quality of life.

The main side effects were nausea and diarrhea. These were typically mild, or moderate, and usually subsided with time. And yet, these side effects were severe enough for 4.5% of the participants in the Semaglutide group to stop taking the medication.

These results sound very encouraging. Especially if one considers that behavioral interventions for weight control, such as diet and exercise, fail more often than not, and that bariatric surgery (surgery performed for weight-loss) is invasive, carries substantial risks, and often results in weight regaining. At the same time, a closer look at the history of weight-loss medications would reveal a chain of unfortunate events where initial enthusiasm was followed by bitter realization and eventual disappointment. In some cases the recognition of serious side effects had led to withdrawal from the market: Amphetamines resulted in addiction; Fenfluramine was toxic to the heart; lorcaserin led to cancer.

And some questions regarding Semaglutide remain unanswered. Will these optimistic results hold true in the real world? Will patients agree to weekly injections, and for how long? Will the weight-loss and other positive effects persist after the medication is discontinued? And perhaps most importantly, are there any unknown, long-term side effects associated with the medication?

And last, there is the question of cost to individuals and to society. On a popular website comparing the price of medications at different pharmacies, I found that the out-of-pocket weekly cost, for an individual without health insurance, is $846.37. It translates to $44,011.24 a year. A bit prohibitive.

A simple calculation I made indicated that for a yearly cost of Semaglutide, I could continue my fitness center membership, at $45 a month, for exactly 81.5 years. I immediately called my gym. “Don’t you worry,” they said, “your yearly plan will be automatically renewed.”

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.


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