What’s next for Ozempic?

Ozempic and other drugs like it have proven powerful in controlling blood sugar and weight loss. Now, scientists are exploring whether they could be equally transformative in treating a host of other conditions, from addiction and liver disease to a common cause of infertility.

It’s like a snowball turned into an avalanche, said Lindsey Allen, a health economist at Northwestern Medicine. As medicines are gaining momentum, he said, they are leaving behind this completely changed landscape.

Most research on other uses of semaglutide, the compound in Ozempic and Vegovy, and tirazepate, the substance in Monjaro and Zepbound, are only in the early stages. One of the biggest questions that scientists are trying to answer is: Are the benefits of these drugs limited to just weight loss? Or do they have other effects, such as reducing inflammation in the body or calming the brain’s compulsive thoughts, which would make it possible to treat far more diseases?

We probably won’t know anytime soon. We are still learning how these drugs work, said Dr. Daniel Drucker, one of the first researchers to study these drugs. (Dr. Drucker consults for Novo Nordisk, the company that makes Ozempic and Vegovy.)

If these trials are successful, people with the conditions below, many of whom have few good options for treatment, may benefit in the long run. And for weight-loss drug makers, each new experiment could propel the drugs even further into blockbuster status. Some of these applications, including heart disease and sleep apnea, which affect millions of people, have become targets for these companies and may prove particularly attractive. Dr. Allen said, these medicines are a gold mine. There is no upper limit to where the market is going.

As evidence from these studies emerges, researchers will have a clearer idea of ​​how these drugs actually work in the body. If they can treat even more diseases, they can shake up the drug again.

alcohol use disorder

Problem

Alcohol use disorder, also known as alcoholism, is common, with approximately 30 million people in the United States having it in 2022. But it’s rare for people to be diagnosed with it, and it’s often exceptionally difficult for them to find a cure. There are effective medications available on the market, but some people who could benefit from them don’t even know they exist.

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Anecdotally, some people who take medications like Ozempic say that the medications cause them to drink less, and in some cases, cause them to stop drinking altogether. Researchers are trying to find out the reason for this. Because people feel full when they take these medications, they may lose interest in alcohol as well as food. It is also possible that because these drugs target parts of the brain that control appetite, they may also affect compulsive behaviors that may involve those areas of the brain, such as using alcohol or stimulants. , gambling, smoking or even biting nails.

preliminary evidence

A small study followed six people with alcohol use disorder who were taking semaglutide for weight loss. After taking the drug for one to nine months, all six drank significantly less alcohol. In an online survey of 153 adults with obesity, most of whom were white and female, those who took semaglutide or tirazepide reported that they drank significantly less alcohol than their peers who did not take the drugs.

Although data is limited, some patients with alcohol use disorders have already begun asking doctors about these medications. Researchers studying how these drugs affect alcohol drinking recently responded to that demand with an article in Nature Medicine, urging doctors not to diagnose alcohol use disorder without more research. Do not use medicines for.

polycystic ovary syndrome

Problem

At least five million people in the United States have polycystic ovary syndrome, or PCOS. This condition is a major cause of infertility and causes irregular menstruation. Treatments available include changes in diet and exercise, birth control pills and the diabetes drug metformin but they do not work for everyone.

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Researchers believe that high testosterone levels contribute to PCOS. When people with this condition lose weight, their testosterone levels often drop. Drugs like Ozempic may help regulate hormones in people with PCOS, said Dr. Melanie Cree, who is leading one of the early studies to investigate whether semaglutide could resolve PCOS symptoms. .

preliminary evidence

A small study of 27 people with obesity and PCOS who took low doses of semaglutide found that after six months, most participants had lost weight and their periods were more regular, which suggests that Her PCOS was under better control. Dr. Cree completed a study of semaglutide in teenage girls with PCOS, which showed similar results, and she is recruiting for another study focused on menstrual regularity.

liver disease

Problem

About 70 percent of people with type 2 diabetes and 50 to 90 percent of people who are obese have nonalcoholic fatty liver disease, or NAFLD, which occurs when excess fat accumulates in the liver. This condition can cause such severe liver damage that some patients may require a liver transplant.

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Doctors usually urge obese or overweight patients with NAFLD to lose weight to reduce the amount of fat and inflammation in the liver. Because drugs like Ozempic help people lose weight, they may also reduce the amount of fat stored in the liver. Type 2 diabetes also increases the risk of NAFLD. By treating this, drugs like Ozempic can also reduce the risk or severity of liver disease.

Scientists have two other theories about how the drugs might help: by improving the insulin resistance common in people with NAFLD and by reducing inflammation that can damage the liver.

preliminary evidence

The Novo Nordisk-funded study found that compared with placebo, semaglutide did not significantly improve the resolution of liver lesions or nonalcoholic steatohepatitis, or NASH, a severe form of nonalcoholic fatty liver disease. The study included people with cirrhosis, or scarred and permanently damaged liver. A large Novo Nordisk-funded trial found that phase 1 patients taking semaglutide were more likely to see resolution of their NASH than those taking a placebo, but were no more likely to see improvement in their scars.

Novo Nordisk is now running a large clinical trial on semaglutide and NASH, and the Food and Drug Administration has designated the drug a breakthrough therapy for the disease, which will expedite regulatory review. Researchers funded by Eli Lilly are also investigating whether tirazepate could treat NASH.

heart problems

Problem

Heart disease will kill nearly 700,000 people in the United States in 2022, making it the leading cause of death in the country. Experts say there is an urgent need for new treatments that could reduce the risk of heart attacks and strokes and improve symptoms like fatigue and shortness of breath that can make it difficult for people with heart disease to get through the day. Are.

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Obesity significantly increases the risk of heart disease, which is why some doctors think that losing weight can treat and prevent heart problems. Medications can also help reduce inflammation, which can cause plaque to build up in the heart and cause blood clots.

preliminary evidence

In November, a major trial showed that semaglutide reduced the risk of events such as heart attack and stroke by 20 percent in obese and overweight people with heart disease. Another trial of people with obesity and a certain type of heart failure found that semaglutide could improve symptoms and make it easier to exercise. Eli Lilly is conducting its own trials on tirazepate and heart failure. More studies are in the pipeline: Researchers are investigating whether semaglutide can reduce plaque in the heart, improve heart failure symptoms or reduce damage from stroke.

sleep apnea

Problem

An estimated 30 million people in the United States suffer from obstructive sleep apnea, in which breathing repeatedly stops and starts during sleep. Treatments such as the use of continuous positive airway pressure, or CPAP, machines can help, although patients often find it uncomfortable. Many people suffering from sleep apnea remain undiagnosed. If it is not treated properly, this condition can have a significant impact on people’s health and increase the risk of complications such as heart disease and type 2 diabetes.

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Sleep apnea is more common in obese people. This is caused by a complex set of factors, including the fact that fat accumulation in the neck can block the airway when a person is lying down. Research has shown that including bariatric surgery can help with weight loss.

preliminary evidence

There is little data so far, although an Eli Lilly spokesperson said the company expects to complete a study of tirazeptide and sleep apnea in the spring of 2024. Novo Nordisk is not currently studying whether semaglutide can treat sleep apnea.

kidney disease

Problem

About one in three adults with type 2 diabetes also has chronic kidney disease, which occurs when the kidneys become damaged and no longer function properly. Patients suffering from this disease may eventually require dialysis or a kidney transplant, and if left untreated, the condition can be fatal.

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Kidney damage happens gradually over time and is irreversible in almost all cases, said Dr. George Bekris, who was involved in the trial of semaglutide in people with type 2 diabetes and chronic kidney disease, which was supported by Novo Nordisk. it was done. Drugs like Ozempic may be able to prevent further damage, partly because weight loss reduces the risk of high blood pressure and type 2 diabetes, which are risk factors for chronic kidney disease.

It’s not entirely clear how these drugs might improve chronic kidney disease, but one possible factor is that they might reduce inflammation, which can become harmfully high in people with the condition.

preliminary evidence

Novo Nordisk announced in October that it had halted a trial of semaglutide in people with type 2 diabetes and chronic kidney disease after early analysis made it clear the drug was effective, though the company has not yet released the data. Is. The company is funding another study to investigate how semaglutide works in the kidneys. Eli Lilly is funding a trial of tirazeptide in people with obesity and chronic kidney disease.

These and other studies are part of what Dr. Howard Forman, a Yale School of Medicine professor who specializes in health policy, calls an explosion of opportunities.

It remains to be seen whether those opportunities could lead to new treatments.

We are in very early stages of progress in this whole industry, and nothing would surprise me,” Dr. Forman said.

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