Weekly Semaglutide for Weight Loss in Adults Save

NEJM has reported the results of a trial showing semaglutide once weekly plus lifestyle intervention was associated with sustained, weight loss in overweight or obese adults; such that nearly one-third lost over 20% of their body weight.

Semaglutide, a once weekly glucagon-like peptide-1 (GLP-1) analog, has been available since 2017 (as Ozempic and Rybelsus) for the treatment of type 2 diabetes.  A common consequence of GLP-1 treatment in diabetics is weight loss of 9-12 lbs.  

This weight loss trial enrolled 1961 non-diabetic adults with a BMI > 30 and ≥1 weight-related coexisting condition. Patients were randomized 2:1 to either once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo, plus lifestyle intervention. The coprimary end points were the percentage change in body weight and weight reduction of at least 5%.

The 68 week mean change in body weight was −14.9% in the semaglutide group as compared with −2.4% with placebo (P<0.001).

The number who achieved weight reductions:

• 5% or more: semaglutide 86.4% vs. PBO 31.5%
• 10% or more: SEM 69.1% vs.  2.0%
• 15% or more 50.5% SEM vs. 4.9% PBO at week 68 (P<0.001 for all comparisons).

The mean change in body weight at week 68 was −15.3 kg in the semaglutide group as compared with −2.6 kg in the placebo group.

Common side effects were nausea and diarrhea (transient, mild-to-moderate and subsided with time). There were more drug disconstinuations with semaglutide than placebo from gastrointestinal events (4.5% vs. 0.8%).

In patients who are overweight or obese, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically important weight loss.