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November 2020

All about Ozempic (Semaglutide)

Semaglutide for weight loss

Recent research shows that semaglutide is an effective medication for weight loss.

Semaglutide however has not yet been licensed for obesity. Semaglutide can be used for weight loss in people with type 2 diabetes and trade name is ozempic. Once the licence for semagalutide for weight loss is available the trade name would be different and would not be called ozempic.

STEP1: Study on semglaglutide

STEP1 study was recently published in the journal The New England Journal of Medicine titled “Once-Weekly Semaglutide in Adults with Overweight or Obesity”, authored by Professor John Wilding, Professor Rachel Batterham and other co-authors.

Semaglutide Treatment Effect in People with obesity (STEP) programme is to investigate the effect of semaglutide compared to placebo on weight loss, safety, and tolerability in adults with obesity or overweight.STEP1 is the first of the trial, which has shown that injection semgalutide 2.4mg once a week is an effective weight loss medication. Over a 68 week period, semaglutide injection given once a week, resulted in about 15% weight loss compared to the people who received placebo(2.4% weight loss).

Ozempic, which is semgalutide licenced for type 2 diabetes is used in a much smaller dose( maximum one milligram) compared to that used in this study for weight loss(2.4milligram).

The research clearly shows that the injection helped people lose weight when combined with healthy life style intervention.More people on this injection discontinued treatment due to side effects. The common side effects noted with semaglutide include nausea and diarrhoea.

This study has generated lot of interest following publications in several tabloids and the BBC website. As mentioned above this medication has not yet been licensed for obesity by the company Novo Nordisk.

The new medication for Type 2 diabetes management, which helps lose weight

As the prevalence of type 2 diabetes increases worldwide, we find that more research is undertaken to help people manage their diabetes well and to prevent complications. A number of new medications have been released in the last 10 years. 90% of the people with Type 2 diabetes are either overweight or obese. We all know that weight loss helps to improve blood sugar control and in some can completely reverse type2 diabetes. In the recent past medications for diabetes are geared to not only reduce blood glucose but also address weight gain.

Here we describe a new medication called Semaglutide, which is GLP-1(Glucagon Like Peptide-1) analogue. The trade name is Ozempic.

What is a GLP-1 analogue?

GLP–1 is a natural hormone that has multiple actions in glucose and appetite regulation.  Blood glucose and appetite is mediated by changes happening in the pancreas and the brain. The hormone Glucagon like Peptide or GLP-1 plays a major role.

GLP-1 reduces blood glucose in a glucose dependent manner by stimulating insulin secretion, which means GLP-1 works only when blood glucose is high and does not stimulate insulin secretion when blood glucose is low. 

GLP-1 also lowers glucagon secretion when blood glucose is high. Glucagon is a hormone which increases blood glucose. Glucagon is usually produced by the pancreas when blood glucose is low. Glucagon converts the glycogen (sugar stores) in the liver to glucose. 

The mechanism of blood glucose lowering also involves a minor delay in gastric emptying after consuming food. During hypoglycaemia or low blood glucose, Semaglutide reduces insulin secretion. 

It is also known to reduce body weight and body fat mass through lowered food intake, reduced appetite. In addition, Ozempic reduces the preference for high fat foods.

How is Ozempic different from the other drugs of the same class?

Semaglutide or Ozempic is a GLP-1 analogue and administered as an injection once a week.

Research shows that Ozempic was superior at reducing HbA1c (Glycosylated haemoglobin, measure of blood glucose control) from baseline compared with dulaglutide, exenatide OW, sitagliptin and insulin glargine. It was superior and resulted in sustained weight loss from baseline compared with dulaglutide, exenatide(weekly), sitagliptin and insulin glargine for all comparisons. Semaglutide (Ozempic) 1 mg demonstrated superior and sustained weight loss of 6.5 kg compared with 3.0 kg with dulaglutide (another GLP-1 analogue).

Treatment with Ozempic resulted in a 26% risk reduction in death from cardiovascular causes, non-fatal heart attack or non-fatal stroke.

Ozempic like other GLP-1 analogues is known to have a beneficial effect on plasma lipids and lowers systolic blood pressure.

Who can be prescribed Semaglutide or Ozempic?

Ozempic is human glucagon-like peptide-1 (GLP-1) analogue produced by recombinant DNA technology. The tradename is Ozempic, manufactured by Novo Nordisk and is available in the following doses: 0.25, 0.5 and 1milligram prefilled pens.

Ozempic® is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise either on its own when metformin cannot be taken for any reason or in combination with other medications for type 2 diabetes. Ozempic is to be administered once weekly at any time of the day, with or without meals. Ozempic is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. 

Ozempic should not be administered intravenously or intramuscularly.

When Ozempic is added to existing therapy of sulfonylurea( like gliclazide, glimepride) or insulin, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycaemia)low blood glucose) 

The starting dose is 0.25 mg Semaglutide once weekly. After 4 weeks the dose should be increased to 0.5 mg once weekly. After at least 4 weeks with a dose of 0.5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control

Self-monitoring of blood glucose is not needed in order to adjust the dose of Ozempic. However, when initiating treatment with Ozempic in combination with a sulfonylurea or an insulin, blood glucose self-monitoring may become necessary to adjust the dose of the sulfonylurea or the insulin to reduce the risk of hypoglycaemia. Always seek advice from your diabetes consultant or diabetes specialist nurse.

Who cannot be prescribed Semaglutide?

Semaglutide should NOT be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Semaglutide is not a substitute for insulin. Semaglutide is currently not licenced for management of obesity (not licenced for weight loss).

Semaglutide is not recommended in patients with heart failure New York Heart Association class IV. 

Acute pancreatitis or inflammation of pancreas has been observed with the use of GLP-1 receptor agonists. Symptoms of acute pancreatitis include abdominal pain, loss of appetite, nausea and vomiting. Seek urgent help if pancreatitis is suspected or go to the nearest A&E.

If pancreatitis is suspected, discontinue semaglutide immediately; if confirmed, semaglutide should not be restarted.  

Patients treated with semaglutide or any GLP-1 analogue in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia (low blood glucose of less than 4mmol/l or 72mg/dl).  The risk can be lowered by reducing the dose of sulfonylurea like gliclazide or insulin, when initiating treatment with GLP-1 analogue.

Women of childbearing potential are recommended to use contraception when treated with

ozempic and therefore, ozempic should not be used during pregnancy as there is no data on its safety in pregnancy.

Is there a tablet form of Ozempic? 

Oral Semaglutide is soon to come to the market and will be useful for people with Type 2 diabetes who are averse to injections and are needle phobic. Oral therapy is convenient for patients and also for health care professionals. Staff training cost and training patients to inject can be avoided with oral therapy.

I will be updating this article once semaglutide gets its licence for weight loss.

Always consult a diabetes specialist when starting Ozempic or when altering the dosage.

Dr C. Rajeswaran FRCP(UK);MSc
Consultant Physician
Obesity, Diabetes & Endocrinology

 

To learn more about Type 2 diabetes and weight loss, click here 

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