Understanding Ozempic and Wegovy, the Drugs at the Center of the Latest Weight Loss Craze

I don’t know about you, but I cringe when I hear the Ozempic (semaglutide) and other pharmaceutical jingles. When I’m watching cable TV, the commercial with the familiar Ozempic jingle pops up almost daily. I knew nothing about this medication until I decided to read about it. In my mind, I assumed it was another medication for type 2 diabetes, and I had no idea that is can also drive weight loss in some people.

In the first seven months of 2023, drug companies spent a whopping $500 million on advertisements for obesity and diabetes treatments. While widely used in treatment of type 2 diabetes, the weight loss potential of Novo Nordisk’s Ozempic is gaining traction, and publicity, with companies such as Optavia, Ro and WeightWatchers each launching a subscription program focused on health and nutrition needs of patients taking these or similar drugs called Glucagon-like peptide-1 receptor agonists (GLP-1RA).

What is a GLP-1RA and What are the Indications For Use?

GLP-1RA medications aren’t just a popular weight loss fad, but rather they are FDA-approved medications to treat obesity and other metabolic disorders like diabetes. Like other GLP-1Ras, Semaglutide—the specific medication in Novo Nordisk’s Ozempic, Wegovy and Rybelsus brands—mimics a hormone that helps the body control blood sugar levels, suppresses appetite, and slows the body’s stomach emptying. This combination of outcomes can lead to weight loss in some patients. Clinical trials have found that GLP-1RA is associated with significant weight loss of up to 10-15% and it has been approved for the treatment of both type 2 diabetes and obesity.¹

The discovery, description, and clinical development of GLP-1 medications spans 30 years with contributions from multiple investigators.² Experimental findings on incretins—AKA gut hormones—were designed to establish the biology of GLP-1 as an insulin-stimulating hormone.² In 2017, the Harrington Prize for Innovative Medicine was awarded for the discovery of GLP-1 and the translation of these findings into transformative therapies for major metabolic changes like diabetes. Incretin hormones are secreted after nutrient intake and stimulate insulin secretion together with hyperglycemia. In diabetes, incretion effect is diminished.²

GLP-1RAs are available as a monotherapy in injectable or oral dosage forms. The FDA has approved GLP-1RAs as a second line treatment option for better glycemic control in type 2 diabetes and it is still under scrutiny for anti-obesity purposes.³ Multiple clinical trials have shown GLP-1RAs reduce cardiovascular risks in patients with diabetes and atherosclerotic cardiovascular disease (ASCVD), or high cardiovascular risk independent of HbA1C. All of the currently available GLP-1RA medications have effects on cardiovascular risk factors including hypertension.⁴ The American Diabetes Association guidelines recommend using GLP-1RA for patients with established ASCVD or indicators of high ASCVD risk independent of A1C levels.

Cost, however, is one major barrier to patients accessing GLP-1RA medications. Subcutaneous weekly injections can cost approximately $1,200.00 per month. Patients can use manufacturer coupons which can give pharmacists time to work with the provider in getting insurance coverage. In addition, providers sometimes can obtain off-label GLP-1RA which can lower cost by about a third.¹

Drug Administration and Side Effects

Most often, GLP-1RAs are injected by pens or insulin syringes with minimal discomfort with different dose frequencies. This medication is titrated up with a starting dose and dose increases until the full dose is reached. Patient counseling is often combined with injections including advice on obtaining optimal health through a combination of strategies including eating smaller meals, eating more slowly, and staying hydrated.

Common side effects are gastrointestinal issues including nausea, vomiting, and diarrhea. The risk of hypoglycemia is minimal with these drugs unless they are used in combination with drugs that cause hypoglycemia.⁴ Patients using these medications may also report severe or persisting abdominal pain and constipation.

GLP-1RAs are contraindicated in pregnant or breastfeeding women, as well as for patients with severe gastrointestinal diseases including pancreatitis, multiple endocrine neoplasia, and medullary thyroid cancer.⁴

Patients with type 2 diabetes who take concomitant glucose-lowering drugs benefit from GLP-1RA independent of Metforin which is commonly used as a first-line medication in the type 2 diabetes patient population.⁴

The American Society of Anesthesiologists (ASA) have recently issued guidance which advises patients taking GLP-1RA to withhold taking these medications prior to elective surgical procedures. There are reported concerns about potential adverse effects and complications associated with these medications during surgery and patients on daily dosing are advised to consider withholding GLP-1RA the day of the procedure. Patients on weekly dosing are advised to withhold GLP-1RA on the week prior to the procedure.⁵

Questions to Ask Patients about GLP-1RA

1. Obtain the name and contact information of the prescribing healthcare team
2. Ask how long they have been taking the medication
3. Ask about their outcomes including how they are feeling on the medication
4. Ask about the frequency of injection
5. Also, ask the patient if any other medications have been altered due to adding a GLP-1RA to their medication regimen
6. Ask about their daily water consumption because it is recommended that they consume 64 ounces a day to aid digestion, minimize or prevent nausea, minimize headaches, and prevent constipation.

In summary, semaglutide is a class of medications known as glucagon-like peptide-1 receptor agonists that are given in the form of subcutaneous injections in patients with type 2 diabetes. It is also now being prescribed for obesity based on clinical trials that have shown semaglutide to be effective in promoting weight loss. These drugs are expensive and often not covered by the patient’s health plan but off-label GLP-1RAs can lower the cost.

The treatment of metabolic diseases like type 2 diabetes and obesity is changing based on the discovery of GLP-1RAs. For some patients to learn that obesity is a treatable medical condition is a life changer.

Listen to your patients as they navigate new ways to achieve successful health outcomes and cheer them on.

References:

1. Loren Bonner. GLP-1 receptor agonists: Breaking down the hype and demand. Pharmacy Today. Published: March 2023. Accessed: February 13, 2024. https://www.pharmacist.com/Publications/Pharmacy-Today/Article/glp-1-receptor-agonists-breaking-down-the-hype-and-demand
2. Drucker DJ, Habener JF, Holst JJ. Discovery, characterization, and clinical development of the glucagon-like peptides. J Clin Invest. 2017;127(12):4217-4227. doi:10.1172/JCI97233
3. Mahapatra MK, Karuppasamy M, Sahoo BM. Semaglutide, a glucagon like peptide-1 receptor agonist with cardiovascular benefits for management of type 2 diabetes. Rev Endocr Metab Disord. 2022;23(3):521-539. doi:10.1007/s11154-021-09699-1
4. Marx N, Husain M, Lehrke M, Verma S, Sattar N. GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation, 146 (2022), pp. 1882-1894
5. January 2024: AAOMS News and Announcements. Journal of Oral and Maxillofacial Surgery. January 2024;82(1):134-136. doi.org/10.1016/j.joms.2023.10.001