Are you afraid to use semaglutide?

Semaglutide can be described as the current star drug, with excellent performance in reducing blood sugar, weight loss, and cardiorenal protection. However, the conclusion of a study published recently and the modification of the drug instructions by the US FDA have aroused the attention of many people, and some even exclaimed that they no longer dare to use semaglutide casually. What is the actual situation? Listen to my simple words~~

On October 5, the famous medical journal JAMA published a study in the form of a brief (JAMA. Published online October 5, 2023. doi:10.1001/jama.2023.19574) (as shown below). A study of 16 million subjects found that treatment with GLP-1 receptor agonists (liraglutide or semaglutide) may increase the risk of gastric paralysis, pancreatitis, and intestinal obstruction. Previously, on September 22, the US FDA had just updated the information on the instructions for semaglutide, pointing out that the drug may increase the risk of intestinal obstruction.

When the sails of semaglutide were hanging, these two pieces of news quickly attracted widespread attention. How to deal with this problem correctly?

First of all, there is an old saying in our country, "A medicine is divided into three parts poison." Any medicine, as long as it can treat a disease, will always have side effects of one kind or another, and the same is true for semaglutide. As the medication period prolongs and real-world data accumulates, people's understanding of the positive effects and adverse effects of the drug will gradually increase. Therefore, the aforementioned research results and the FDA's modification of the instructions are a very normal phenomenon and not surprising; secondly, based on the existing research results in various aspects, semaglutide is of course a very excellent drug, which not only lowers blood sugar, but also It can improve the macrovascular prognosis of patients with type 2 diabetes; it not only has a significant weight loss effect, but also reduces the risk of cardiovascular events in obese patients; in addition, recent studies have also found that the drug can help improve the prognosis of renal endpoints. Therefore, these newly discovered potential adverse reactions can be described as "flaws do not hide the advantages".

Even with this hiccup, there is no denying that semaglutide is still an excellent drug. Why do you say this way?

Among many types of antidiabetic drugs, GLP-1 receptor agonists and SGLT-2 inhibitors can be nicknamed “miracle drugs”. The anti-diabetic drug metformin, which has been "conferred as a god" for more than half a century, is just a kind of anti-diabetic drug. Although the two new drugs have been on the market not long ago, they have demonstrated their excellent effects and broad application prospects in many aspects.

Among several GLP-1 receptor agonists commonly used in clinical practice, semaglutide is considered the leader. Semaglutide, which was launched as a hypoglycemic drug, was approved by the US FDA in 2017 for the hypoglycemic treatment of patients with type 2 diabetes. In addition to its reliable hypoglycemic effect, the results of the SUSTAIN-6 study that ended in 2016 made semaglutide the second GLP-1 receptor agonist drug confirmed to have cardiovascular benefits after liraglutide. , which is also the third antidiabetic drug proven to have cardiovascular benefits after empagliflozin and liraglutide. Based on this study, the drug was approved by the FDA in early 2020 to reduce the risk of major cardiovascular events in patients with type 2 diabetes and cardiovascular disease.

Subsequently, foreign scholars used semaglutide to conduct a series of useful explorations in the field of weight loss in obese patients and achieved promising results. The STEP series of studies (STEP 1, STEP 2, STEP 3, STEP 4) designed and implemented on subjects with different baseline characteristics have confirmed from different aspects that the drug has an ideal weight loss effect. Among them, the STEP1/3/4 study showed that 68 weeks of treatment with semaglutide can reduce the weight of subjects by 15% to 18%, and has good safety. Based on these studies, the US FDA approved semaglutide in June 2021 for weight management in obese or overweight adults.

Not only that, the SELECT study, which ended two months ago, adopted a randomized, double-blind, parallel group, placebo-controlled design and was designed to evaluate overweight or obese non-diabetic patients with cardiovascular disease. Effect of glutide 2.4 mg on the incidence of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke). A total of 17,604 subjects aged ≥45 years and with a BMI ≥27 who met the aforementioned conditions were enrolled and randomly treated with semaglutide (2.4 mg per week) or placebo, with a follow-up period of approximately 5 years. Preliminary results show that compared with the placebo group, the incidence of major adverse cardiovascular events in the semaglutide treatment group was reduced by about 20%, and the safety and tolerability were good. This study is the first to demonstrate that semaglutide treatment can not only effectively reduce weight, but also significantly reduce the risk of major composite cardiovascular endpoints, which is therefore landmark.

Also, on October 10, the researchers announced the early termination of the FLOW study, which was designed to explore the effectiveness of semaglutide in patients with type 2 diabetes combined with chronic kidney disease. An interim analysis showed that the incidence of major adverse renal events was significantly reduced in the semaglutide treatment group, so the decision was made to terminate the study early. This research result provides very important new evidence for the renal protective effect of semaglutide.

Existing research shows that semaglutide has good effects in many aspects such as hypoglycemic treatment, weight management, and heart, brain, and kidney protection. These evidences are enough to support it as an excellent drug. Even if new research finds that it has flaws of one kind or another, it will not affect the drug's good clinical performance and application prospects. After all, commonly used hypoglycemic drugs have side effects of one kind or another, especially among weight loss drugs. For these new discoveries, we just need to pay attention to monitoring during the medication process and make appropriate responses when necessary.

No need to make a fuss!