Clinical Insight on Semaglutide for Chronic Weight Management in Adults: Patient Selection and Special Considerations

Overview

Journal Drug Des Devel Ther

Specialty Pharmacology

Date 2023 Jan 5

PMID 36601368

Authors

Ariana M Chao

Jena Shaw Tronieri

Anastassia Amaro

Thomas A Wadden

Affiliations

Soon will be listed here.

Abstract

Losses of 5-10% or more of initial body weight are associated with improvements in obesity-related comorbidities. However, attaining and sustaining this level of weight loss is challenging. The novel anti-obesity medication semaglutide 2.4 mg injected subcutaneously once weekly as an adjunct to a reduced-calorie diet and physical activity helps patients achieve average losses of 9.6-17.4% of initial body weight at week 68, as well as improvements in cardiometabolic and psychosocial indices. Despite these average benefits, prescribers should carefully assess the suitability of patients for this medication. In this paper, we discuss considerations for the selection of individuals who are candidates for semaglutide and special considerations related to the use of this medication. These include its efficacy and safety, as well as its contraindications, potential adverse effects, management of comorbidities and drug interactions, insurance coverage and cost, and patient preferences.

Citing Articles

Semaglutide: Double-edged Sword with Risks and Benefits.

Pillarisetti L, Agrawal D Arch Intern Med Res. 2025; 8(1):1-13.

PMID: 39902055 PMC: 11790292. DOI: 10.26502/aimr.0189.

Effect of Silibinin on Human Pancreatic Lipase Inhibition and Gut Microbiota in Healthy Volunteers: A Randomized Controlled Trial.

Ponce Martinez C, Murcia Garcia E, Perez Sanchez H, Milagro F, Riezu-Boj J, Ramos Molina B Int J Mol Sci. 2024; 25(23.

PMID: 39684564 PMC: 11640983. DOI: 10.3390/ijms252312853.

Role of Incretin Mimetics in Cardiovascular Outcomes and Other Classical Cardiovascular Risk Factors beyond Obesity and Diabetes Mellitus in Nondiabetic Adults with Obesity: a Meta-analysis of Randomized Controlled Trials.

Kamarullah W, Pranata R, Wiramihardja S, Tiksnadi B Am J Cardiovasc Drugs. 2024; 25(2):203-229.

PMID: 39616304 DOI: 10.1007/s40256-024-00695-9.

Effect of Semaglutide in Individuals With Obesity or Overweight Without Diabetes.

Alanazi M, Alshahrani J, Sulayman Aljaberi A, Alqahtani B, Muammer M Cureus. 2024; 16(8):e67889.

PMID: 39328692 PMC: 11425063. DOI: 10.7759/cureus.67889.

Semaglutide use in people with obesity and type 2 diabetes from real-world utilization data: An analysis of the All of US Program.

Mayer C, Fontelo P Diabetes Obes Metab. 2024; 26(11):4989-4995.

PMID: 39248157 PMC: 11462475. DOI: 10.1111/dom.15911.

References

Hollander P, Gupta A, Plodkowski R, Greenway F, Bays H, Burns C . Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care. 2013; 36(12):4022-9. PMC: 3836105. DOI: 10.2337/dc13-0234. View

Marso S, Bain S, Consoli A, Eliaschewitz F, Jodar E, Leiter L . Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016; 375(19):1834-1844. DOI: 10.1056/NEJMoa1607141. View

West D, Prewitt T, Bursac Z, Felix H . Weight loss of black, white, and Hispanic men and women in the Diabetes Prevention Program. Obesity (Silver Spring). 2008; 16(6):1413-20. DOI: 10.1038/oby.2008.224. View

Hu W, Song R, Cheng R, Liu C, Guo R, Tang W . Use of GLP-1 Receptor Agonists and Occurrence of Thyroid Disorders: a Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne). 2022; 13:927859. PMC: 9309474. DOI: 10.3389/fendo.2022.927859. View

Ryan D, Yockey S . Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. Curr Obes Rep. 2017; 6(2):187-194. PMC: 5497590. DOI: 10.1007/s13679-017-0262-y. View

Jensen J, Binderup T, Grandjean C, Bentsen S, Ripa R, Kjaer A . Semaglutide reduces vascular inflammation investigated by PET in a rabbit model of advanced atherosclerosis. Atherosclerosis. 2022; 352:88-95. PMC: 9241989. DOI: 10.1016/j.atherosclerosis.2022.03.032. View

Kadowaki T, Isendahl J, Khalid U, Lee S, Nishida T, Ogawa W . Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol. 2022; 10(3):193-206. DOI: 10.1016/S2213-8587(22)00008-0. View

Frias J, Davies M, Rosenstock J, Perez Manghi F, Lando L, Bergman B . Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 2021; 385(6):503-515. DOI: 10.1056/NEJMoa2107519. View

Zinman B, Bhosekar V, Busch R, Holst I, Ludvik B, Thielke D . Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019; 7(5):356-367. DOI: 10.1016/S2213-8587(19)30066-X. View

10.

Ahmann A, Capehorn M, Charpentier G, Dotta F, Henkel E, Lingvay I . Efficacy and Safety of Once-Weekly Semaglutide Versus Exenatide ER in Subjects With Type 2 Diabetes (SUSTAIN 3): A 56-Week, Open-Label, Randomized Clinical Trial. Diabetes Care. 2017; 41(2):258-266. DOI: 10.2337/dc17-0417. View

11.

Zeng Q, Li N, Pan X, Chen L, Pan A . Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol. 2021; 9(6):393-405. DOI: 10.1016/S2213-8587(21)00047-4. View

12.

Steinberg W, Buse J, Muus Ghorbani M, Orsted D, Nauck M . Amylase, Lipase, and Acute Pancreatitis in People With Type 2 Diabetes Treated With Liraglutide: Results From the LEADER Randomized Trial. Diabetes Care. 2017; 40(7):966-972. DOI: 10.2337/dc16-2747. View

13.

Pratley R, Aroda V, Lingvay I, Ludemann J, Andreassen C, Navarria A . Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018; 6(4):275-286. DOI: 10.1016/S2213-8587(18)30024-X. View

14.

Madsbad S, Holst J . Cardiovascular effects of incretins: focus on glucagon-like peptide-1 receptor agonists. Cardiovasc Res. 2022; 119(4):886-904. DOI: 10.1093/cvr/cvac112. View

15.

Costante G, Meringolo D, Durante C, Bianchi D, Nocera M, Tumino S . Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab. 2006; 92(2):450-5. DOI: 10.1210/jc.2006-1590. View

16.

Mosenzon O, Blicher T, Rosenlund S, Eriksson J, Heller S, Hels O . Efficacy and safety of oral semaglutide in patients with type 2 diabetes and moderate renal impairment (PIONEER 5): a placebo-controlled, randomised, phase 3a trial. Lancet Diabetes Endocrinol. 2019; 7(7):515-527. DOI: 10.1016/S2213-8587(19)30192-5. View

17.

Abd El Aziz M, Cahyadi O, Meier J, Schmidt W, Nauck M . Incretin-based glucose-lowering medications and the risk of acute pancreatitis and malignancies: a meta-analysis based on cardiovascular outcomes trials. Diabetes Obes Metab. 2019; 22(4):699-704. DOI: 10.1111/dom.13924. View

18.

Knudsen L, Lau J . The Discovery and Development of Liraglutide and Semaglutide. Front Endocrinol (Lausanne). 2019; 10:155. PMC: 6474072. DOI: 10.3389/fendo.2019.00155. View

19.

Ji L, Dong X, Li Y, Li Y, Lim S, Liu M . Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as add-on to metformin in patients with type 2 diabetes in SUSTAIN China: A 30-week, double-blind, phase 3a, randomized trial. Diabetes Obes Metab. 2020; 23(2):404-414. PMC: 7839591. DOI: 10.1111/dom.14232. View

20.

Husain M, Birkenfeld A, Donsmark M, Dungan K, Eliaschewitz F, Franco D . Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2019; 381(9):841-851. DOI: 10.1056/NEJMoa1901118. View