Endocrine Abstracts

Background: Obesity, a chronic relapsing disease, has become a global public health challenge. Semaglutide, a weekly glucagon-like peptide-1 (GLP-1) agonist which has shown unprecedentedly high efficacy in randomised controlled trials, was recently approved in Europe for weight loss. There is paucity of real-life data about its effectiveness and safety for weight management.

Methods: Our aim was to evaluate the changes in weight and metabolic parameters as well as the side effects of semaglutide use for weight management in a real-life clinical setting. Retrospective review of data on off-label semaglutide use in a weight management clinic in Athens, Greece, for adults with body mass index (BMI) > 30 kg/square meter with at least 3-month follow-up. Patients with diabetes mellitus were excluded. All patients received standard advice about reducing calorie intake and regular physical activity.

Results: Real-world data analysis included 25 patients (19 females, 6 males) with median age 46 years, weight 106.9 kg and BMI 38. Amongst those, eight patients had BMI 30-35, six 35-40, five 45-50, and six > 45. Four individuals had undergone bariatric operation in the past, while four had received medications for obesity. The most common weight-related comorbidities were dyslipidaemia (19/25), prediabetes (15/25), non-alcoholic fatty liver disease (12/25), obstructive sleep apnoea (5/25), depression (5/25) and hypertension (4/25). The median 12-week percentage weight loss was 7.1%, with 72% and 12% of patients achieving > 5% and > 10% weight loss, respectively. The median 24-week percentage weight loss was 13.5% with loss exceeding 5% and 10% of the baseline weight in 87% and 68% of cases, respectively. At week 24, half patients received weekly semaglutide dose of 2.0 mg and the remaining 1.0 mg due to cost reasons. The median percentage weight loss was similar, 12.7% for 2.0 mg and 13.8% for 1.0 mg dose. After 24-week semaglutide therapy, median fasting glucose decreased from a median baseline of 5.7 mmol/l to 5.0 mmol/l. The discontinuation rate was 5%, with only one case of semaglutide withdrawal due to protracted vomiting, while pancreatitis and gallbladder disease were excluded. All other patients had no or minor gastrointestinal symptoms.

Discussion: Real-world data confirm the effectiveness and safety of semaglutide for weight management. Semaglutide could herald a new era in the treatment of obesity, provided public funding ensures wide patient access. This case series reports great potency of semaglutide at the lower dose of 1.0 mg which needs to be explored further.