2023-12-16 09:00:35
The anti-diabetic drug awarded by Science: stars use it to lose weight, but it must be administered under medical supervision. Proven positive effects on heart failure and the risk of heart attacks and strokes
The American scientific journal Science has named the development of GLP-1 (glucagon like peptide-1) receptor agonist drugs the discovery of the year. Developed for diabetes, these molecules induce significant weight loss, with mostly manageable side effects. This year, clinical trials have found that they also reduce the symptoms of heart failure and the risk of heart attacks and strokes, we read in the article justifying the decision.
The winning molecule is the one that gets talked about a lot: semaglutide, brought to the fore in the United States because it is used to lose weight by celebrities who have confessed to using it extensively.
The molecule works by calming the sense of hunger and, at the level of the gastrointestinal tract, slowing down gastric emptying. Efficacy data, in studies that evaluated weight loss for the purposes of drug registration, described an average weight loss of 16% in one year. The journal Science, however, probably chose this class of drugs not only because they make you lose weight, but because they seem to have a protective effect on the heart: a study published in
New England Journal of Medicine a novembre demonstrated a reduction in cardiovascular risk in non-diabetic patients treated with semaglutide. A previous work published in September in the same journal had described the effectiveness of the drug in containing symptoms related to heart failure.
The introduction of these drugs, in particular semaglutide, into the treatment of obesity represents a true revolution – declares Luca Busetto, past President of the Italian Obesity Society (SIO) –. They are extremely effective molecules, normally well tolerated, of which we have very long experience in patients with type 2 diabetes without ever having been reported any particular problems. They have a very significant effect on the desire for hunger (and therefore on weight loss), but at the same time they bring a great benefit in terms of preventing complications related to obesity.
Like all drugs, they must be taken under strict medical supervision because they are used to treat an illness and can have side effects: There are people who use them for their desire to be thin and not for the treatment of an illness and this is a problem – says Busetto – . The most common side effects are nausea (mostly), vomiting or diarrhea. They are usually transitory because the stomach tends to adapt, but in some cases gastric paralysis, pancreatitis and intestinal obstructions have been recorded.
As Science specifies, the good initial data does not answer some questions that remain open and the current critical issues.
The questions concern the duration of the treatment (a subcutaneous injection once a week), the possible long-term effects and the need to take the drug forever to not regain the lost weight: The longest study so far is the one published in November based on 17,500 patients monitored for 4 years, the “Select” trial – confirms the expert -. Stopping the drug will most likely cause you to gain weight back, as happens with hypertension or other disorders when you stop taking the drugs.
The critical issues concern the availability of semaglutide, given that the success of the molecule has led to a disproportionate demand beyond the medical indications. Suffice it to say that in the United States there have been reports of individuals reaching malnutrition or even to intoxication due to drug overdose analogues purchased on the internet or prepared by pharmacies: cheaper, not approved, nor controlled or dosed.
The abuse of those who want to take semaglutide to lose weight without medical indications has led to decompensations. And the media exposure that the use of these drugs has received from stars, who say on social media that they have lost weight with semaglutide, has not helped patients, even diabetics, who have been using the drug for years and now risk never find it again.
The positive effect was that we began to think of obesity as a disease. A concept that is still difficult to accept, says Busetto.
In Italy these molecules are not approved for obesity, but only for diabetes, and on November 14th the Italian Medicines Agency (Aifa) issued a note in which it predicted intermittent shortages for semaglutide throughout 2024 and for the liraglutide (a molecule of the same class) deficiencies at least until the second quarter of 2024.
What alternative pharmacological options do obese patients in our country have? There are currently three authorized drugs and none have been approved by the National Health Service – the specialist replies -: orlistat, which works by reducing the absorption of fats at the intestinal level, but is little used because it induces important intestinal side effects. Then we have a drug that combines two molecules, bupropion and naltrexone, and reduces the urge to eat. Bupropion an antidepressant and naltrexone an anti-opioid. It reduces weight by 8 to 10% in a year, but can cause side effects including increased blood pressure and many obese patients have a history of hypertension. Third drug liraglutide, a drug from the same family as semaglutide, the previous generation. To be administered subcutaneously once a day. It has a weight loss of 8-10%, a little less effective.
The future in the next 5 years is to have at least four or five other molecules similar to semaglutide, also administrable orally. We will have a certain number of drugs with different mechanisms of action, a bit like we have for hypertension, concludes Busetto.
And other studies are underway on the use of GLP-1 receptor agonists: in the treatment of drug addiction, Alzheimer’s disease and Parkinson’s disease, due to the ability of these molecules to act by modifying and regulating the activity of some centers of the central nervous system.
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December 16, 2023 (changed December 16, 2023 | 08:00)
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