Semaglutide, the main ingredient in Ozempic and Wegovy, could soon be used for a lot more than weight loss.
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.
What can’t Ozempic and Wegovy do?
The blockbuster semaglutide drugs have seen unprecedented demand over the past year after studies found that the medications, originally developed for type 2 diabetes, were remarkably effective in helping people lose weight. Patients lost an average of 15 percent of their body mass in clinical trials that launched a media and medical frenzy.
The hype train was out of the station and picking up speed. Ozempic became (to the concern of medical professionals) the diet drug of choice for the celebrity set. Then more data began pouring in, affirming that the drugs were not only helping people lose weight but improving their prognosis for other weight-related medical problems that rank among the most common causes of death in the United States: heart attacks, stroke, and heart failure. A study partially funded by Novo Nordisk, the drugs’ manufacturer, estimated that the product could help prevent as many as 1.5 million heart attacks and strokes over 10 years.
But wait — there’s more.
Semaglutide doesn’t directly target fatty tissue; it works on the human brain to help patients lose weight by reducing their cravings to eat. Researchers have begun to consider applications that had nothing to do with the medicine’s original purpose. Scientists soon announced they were exploring Ozempic’s potential for slowing down dementia and treating substance abuse disorder. Novo Nordisk is funding trials to treat fibrosis for people with non-alcoholic fatty liver disease. Other clinicians say they also are eyeing the drug’s potential for treating polycystic ovary syndrome or PCOS, one of the leading causes of infertility.
Then last week came the news that semaglutide could, in the words of one researcher, “change the whole natural history of type 1 diabetes.” A century ago, the synthesis of insulin gave type 1 diabetics a chance to lead a longer, healthier life. Now a very small study provided a glimpse of a future where it might not be needed at all.
For drug makers, this search for Ozempic’s other clinical applications is just smart business. Previous blockbuster drugs have later been approved for uses that seemed to have little to do with their original purpose: Viagra was initially developed to be a blood pressure drug.
People who work in drug development sometimes talk about a “pipeline in a pill” — “the notion of a molecule that is able to treat a large number of different indications,” said Darius Lakdawalla, a health care economist who studies the pharmaceutical industry at the University of Southern California.
With rivals to Ozempic and Wegovy already in the works, finding new applications for those drugs is one way for their manufacturer to stay a step ahead of the competition.
But for patients, the firehose of new clinical findings and media speculation might feel overwhelming. I spoke with several experts to try to make sense of the hype. The picture that emerges is of a drug with genuinely enormous potential — but plenty of uncertainty ahead.
Ozempic holds serious potential for addressing cardiovascular problems — if the health system can afford it
Semaglutide’s utility in treating the many health conditions associated with obesity is intuitive. If patients can reduce their body weight by 15 percent or more, they can usually lower their blood pressure and cholesterol, thereby lessening the chances that they will have a heart attack or a stroke.
“The fact that the drugs lead to substantial weight loss and weight is tied to every outcome under the sun, it is no surprise to me that they would add these outcomes in trials related to the drugs.” said Stacie Dusetzina, a health policy professor at Vanderbilt University.
And, so far, research supported by Novo Nordisk has borne out that premise. In early August, the company announced that a large clinical trial had found taking semaglutide reduced the risk of a major cardiovascular event for overweight or obese patients 45 years or older by 20 percent when compared to a placebo. (These findings were preliminary; full results will be released later this year.)
In late August, the New England Journal of Medicine published the results of another, smaller study that examined how Wegovy affected people with the most common form of heart failure. The study, which was also supported by Novo Nordisk, found that patients who took Wegovy had fewer symptoms, fewer physical limitations, greater capacity for exercise, and more weight loss than patients who took a placebo.
The lead researcher told CNN that the results were “the largest treatment benefit we’ve ever seen” by those metrics.
Ozempic and Wegovy clearly hold real potential for treating cardiovascular conditions, though research will continue in order to confirm these early findings. The bigger question is cost.
As I’ve previously written, health insurers generally don’t pay for Ozempic and Wegovy. Medicare and Medicaid don’t cover weight-loss drugs as a rule, and most private health insurers don’t either. If a patient and their doctor do think the drug should be covered, they may still have to meet certain conditions (such as requiring tests or other documentation) before a health insurer will agree to pay for the medicine. Without insurance, these drugs cost upward of $1,000 per month — prohibitive for a lot of patients who may benefit from using them.
Their potential to save lives has been part of the argument from doctors that insurers should pay up. But countervailing evidence has complicated the debate. Bloomberg reported at the end of August on another study that concluded insurers may have to spend up to $1 million on the semaglutide drugs at their current prices in order to save a single life.
Still, the evidence for Wegovy’s benefits for cardiovascular health overall seems strong.
Using Ozempic to treat other conditions is more speculative for now — but a lot more research needs to be done
In a strange twist of science, semaglutide is showing promise for a different variation of the disease for which it was first approved six years ago: diabetes.
Ozempic first came onto the market in 2017 to treat type 2 diabetes, the more common version of the disease that is often associated with obesity. For people with type 2, insulin is sometimes but not always necessary; diet and exercise can go a long way too. But for people who have type 1 diabetes, which is rarer and tends to develop earlier in life, insulin has been a lifeline since it was first produced for human use 100 years ago.
But Ozempic may be able to change that reality too. In a small study of 10 patients who were recently diagnosed with type 1 diabetes, seven of them were able to stop taking any kind of insulin within six months. Their bodies improved in producing insulin and their blood sugar was more stable.
One of the lead researchers described the findings as “like science fiction.” But his peers added an important caveat that applies to many of the more adventurous applications of Ozempic: “We need a much more rigorous study to really confirm the results,” Dr. Daniel Drucker, a leading semaglutide researcher, told CNN.
The same is true for the drug’s potential for substance abuse and dementia.
People who work in addiction treatment say Ozempic and Wegovy have spurred a lot of conversation in their field. But the evidence isn’t there yet. One study involving mice, published in 2021, found that using a similar agent did not seem to have an effect on cocaine use, but people who have taken semaglutide have self-reported reduced alcohol consumption.
Dementia is one of several conditions for which semaglutide’s ability to improve cardiovascular health may also contribute to other, less obvious health benefits. Heart health is a risk factor for dementia, and there are preliminary studies from Denmark that suggest people on semaglutide had a lower rate of dementia. More robust studies are now underway. Likewise, weight and heart health are associated with risk for PCOS, which can lead to irregular periods and infertility, and scientists are optimistic that Ozempic and Wegovy could lead to better health outcomes for those conditions too.
It is an exciting moment and there are legitimate reasons to be hopeful about Ozempic’s potential. But we are still in the early chapters of this remarkable story. There is a long way to go.
Source: vox.com
