Finding to be extremely effective in treating risk factors for stroke, American Stroke Association incorporates the important new class of drug GLP-1 agonists.

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The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.

In their recommendations, the ASA urges healthcare professionals to carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.

The new stroke guidelines highlight unique risk factors for females and transgender women and how social determinants of health impact stroke risk.

The guidelines also emphasize the benefits of GLP-1 drugs for cardiovascular health, and encourage a balanced diet, regular physical activity, maintaining a healthy weight, and getting adequate sleep.

The Centers for Disease Control and Prevention (CDC) estimatesTrusted Source nearly 800,000 people have a stroke every year in the United States. Of these, more than 600,000 will be a first-time stroke.

For the first time in 10 years, the American Stroke Association (ASA) has updated its guidelines for reducing stroke risk. According to an ASA news releaseTrusted Source, up to 80% of strokes may be preventable through diet and lifestyle changes and other modifications.

The 2024 Guideline for the Primary Prevention of StrokeTrusted Source also urges healthcare professionals to carefully screen individuals for stroke risk factors, including: High Blood Pressure, Elevated Cholesterol Levels, High Blood Sugar and Obesity.

Many of the new stroke guidelines coincide with the American Heart Association’s Life’s Essential Trusted Source, which promotes cardiovascular and brain health. The lifestyle factors in the ASA’s new stroke guidelines include a healthy diet, regular exercise, better sleep, and smoking cessation.

“Patients looking to reduce their stroke risk (and cardiovascular disease risk in general) should strive to follow the American Heart Association’s Essential 8 recommendations for healthy living,” said Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California. Chen wasn’t involved in the new guidelines.

“We recommend that people eat a healthy balanced diet, engage in regular physical activity, get an adequate amount of sleep, maintain a healthy weight, avoid tobacco and alcohol, reduce stress, and control their blood pressure and cholesterol numbers,” Chen told Healthline.

Overall, the guidelines provide a clear pathway for medical professionals and their patients. The guidelines also call for more public awareness and education about how people can lower their risk of stroke.

New guidelines for stroke prevention from the American Stroke Association emphasize the benefits of GLP-1 drugs, a balanced diet, regular physical activity, and maintaining a healthy weight. PIKSEL/Getty Images

Women face unique stroke risk factors

The updated stroke guidelines recommend that medical professionals screen for conditions that can increase the risk of stroke in females.

Stroke risk factors affecting females include the use of oral hormonal contraceptives, developing high blood pressure during pregnancy, and pregnancy complications, such as: Premature birth, Endometriosis, Premature ovarian failure and Early-Onset Menopause.

The guidelines also note that transgender women and gender-diverse individuals taking estrogen may also be at an increased risk of stroke.

Social determinants of health and stroke risk

The new stroke recommendations emphasizeTrusted Source “social drivers of health.” These non-medical factors include inequities in healthcare, education, economic stability, and structural racism.

The ASA adds that neighborhood factors such as a lack of walkability and access to healthy food also play a role. The guidelines urge medical professionals to advocate for patients in these circumstances.

“Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk,” said Cheryl Bushnell, MD, a professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in North Carolina, in a news releaseTrusted Source. Bushnell is chair of the group that wrote the new guidelines.

“This guideline is important because new discoveries have been made since the last update 10 years ago,” she continued. “Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.”

José Morales, MD, a vascular neurologist and neurointerventional surgeon at Providence Saint John’s Health Center in California Morales echoed the importance of primary stroke prevention and said the guidelines were long overdue. Morales wasn’t involved in developing the new guidelines.

“The focus on equitable access to healthcare, social determinants of health, and gender-specific recommendations are important additions to guiding clinical practice in an evidence-driven matter,” he told Healthline.

GLP-1 drugs may reduce stroke risk

The ASA’s guidelines include a new recommendation for healthcare professionals to consider prescribing GLP-1 weight loss drugs, such as Ozempic, Mounjaro, Zepbound, and Wegovy.

The medications, which have been approved by federal regulators as treatments for obesity or type 2 diabetes, have shown promise in clinical trials in improving cardiovascular health and reducing the risk of stroke.

Chen said the inclusion of newer topics such as weight-loss drugs into the new guidelines is an important step.

“These updated guidelines also incorporate the important new class of drug (GLP-1 agonists) that we are finding to be extremely effective in treating those same risk factors for stroke,” Chen noted.

Healthy diet for stroke prevention

One of the most important things you can do to prevent a stroke is to maintain a healthy, balanced diet.

The new guidelines urge people to stick closely to a Mediterranean diet. This diet focuses on the eating habits of people who live along the Mediterranean Sea.

That plan encourages people to consume more fruits and vegetables as well as legumes, nuts, seeds, and heart-healthy fats. It discourages the consumption of processed foods, added sugars, refined grains. It also recommends limiting the consumption of alcohol.

“Risk factors for stroke vary by age, gender, genetics, comorbidities, and even medications. Therefore, I think the suggestion of screening for not only the basic risk factors but also secondary factors is essential to prescribe the right lifestyle interventions,” said Kristin Kirkpatrick, MS RDN, a dietitian at the Cleveland Clinic Department of Wellness & Preventive Medicine in Ohio. Kirkpatrick wasn’t involved in the new guidelines.

“For my patients, I will often also recommend a Mediterranean pattern, but then work with the patient to assess tweaks to that pattern,” she told Healthline.

“For example, with someone who has insulin resistance or type 2 diabetes, I may focus on a more moderate carbohydrate version of the Med diet. For patients with high blood pressure, I may counsel more on a low sodium perspective. The most important component, however, may be to focus as a whole on a more plant-forward approach that limits ultra-processed foods, sugar, refined grains, and excess amounts of alcohol,” Kirkpatrick continued.

“I also recommend nutrigenomics testing for my patients as well to be able to get a truly personalized approach to prevention based on genetics,” she said.

Exercise and stroke prevention

The guidelines recommend that healthcare professionals screen patients for sedentary behavior and counsel them to engage in regular exercise.

As noted by the ASA’s news releaseTrusted Source, physical activity is “essential for stroke risk reduction and overall heart health.”

The CDC recommendsTrusted Source that adults get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity. That exercise should be spread throughout the week.

Regular exercise can help improve metrics such as blood pressure, cholesterol levels, inflammatory markers, insulin resistance, and overall weight.

“A combination of both aerobic and anaerobic is essential to focus on both muscle retention (and growth) as well as cardiovascular health. Flexibility is also an important factor,” Kirkpatrick said.

Credit: healthline.com

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Given their effects on various organs, they could potentially help you remain functional

“New diabetes drugs may delay ageing” made headlines across the media. The reference was to a study using glucagon-like peptide receptor agonist (GLP1RA), which mimics the hormone incretin to regulate appetite and blood glucose levels. Semaglutide, popularly known as Ozempic, belongs to this class of drugs and is known for controlling blood sugar, suppressing hunger and reducing weight. Are they truly anti-ageing, too?

What is ageing?

Ageing is a highly complex biological process. Our DNA is constantly being broken down and repaired. An imbalance in this process, leading to poor repair of DNA, is one of the hallmarks of ageing. Telomere shortening, deranged protein metabolism and altered sensing of nutrients are other features. These changes lead to cellular senescence (cells lose their power to grow and multiply), reduced tissue regeneration and reduced communication between cells.

Some of the “anti-ageing” benefits seen with GLP1RAs may simply be the result of their weight-loss inducing properties. (File image)

What’s the link between weight loss drugs and ageing?

GLP1RAs have been shown to protect against oxidative stress, cellular senescence and chronic inflammation, which are widely accepted as the major risk factors of ageing. This is characterised by memory loss, cognitive impairment and coordination deficits. Recent studies suggest that GLP1RAs could have beneficial neuroprotective effects. A large study from Sweden showed that in people with Type 2 diabetes, the use of GLP-1RA was associated with 23-30 per cent lower risk of dementia, compared with other anti-diabetic agents.

There are several common pathological processes in Alzheimer’s Disease, a brain disorder that causes a gradual decline in memory and thinking skills, and Type 2 diabetes. These include impaired glucose metabolism, insulin resistance, increased oxidative stress and increased inflammation. Alzheimer’s Disease has been referred to as diabetes of the brain.

What’s their efficacy in managing diseases?

GLP1RAs have shown great promise in treating Alzheimer’s and have also shown some efficacy in treating Parkinson’s disease. Definitive, larger studies are ongoing on this subject. Some of the “anti-ageing” benefits seen with GLP1RAs may simply be the result of their weight-loss inducing properties. Obesity promotes the development of Type 2 diabetes, heart disease and early death. Reduction in body weight can prevent, delay or reduce the development of these conditions with advancing age.

GLP-1RAs, including semaglutide, have been shown to reduce the risk of cardiac complications in people with Type 2 diabetes. The SELECT trial tracked more than 17,600 people, aged 45 or older, as they were given either 2.4 mg of semaglutide or a placebo for more than three years. Participants were obese or overweight and had cardiovascular disease but were not diabetic. Men and women who took the drug died at a lower rate from all causes, including cardiovascular issues and Covid-19. People using the weight-loss drug were less likely to die from Covid (2.6 per cent vs 3.1 per cent). Heart failure, too, was lower in the semaglutide group.

Results of the FLOW trial published earlier this year showed that semaglutide slowed the progression of kidney disease in people with diabetes by 24 per cent. Studies have further shown a reduction in fatty liver disease with GLP-1RAs. Reduction in liver fat could reduce chances of chronic liver disease and its serious, at times fatal consequences.

One concern with the use of GLP1RAs is the muscle loss that accompanies profound weight loss — such muscle loss can potentially lead to frailty, falls and fractures, and prove to be a negative impact of this class of drugs in the elderly.

Credit: The Indian Express

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Credit: You Tube Channel 60 Minutes

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AstraZeneca (AZN.L), opens new tab said on Monday its experimental weight-loss pill, licensed a year ago from China’s Eccogene for up to $2 billion, was safe and tolerable in an early-stage trial, with side effects consistent with the GLP-1 drug class.

Sharon Barr, executive vice president of biopharmaceuticals R&D, said AstraZeneca had progressed the drug into Phase II clinical trials based on the data from Phase I, which assessed its safety and tolerability in 72 participants who were either healthy, non-obese volunteers or people with type 2 diabetes.

The logo for AstraZeneca is seen outside its North America headquarters in Wilmington, Delaware, U.S., March 22, 2021. REUTERS/Rachel Wisniewski/File Photo

AstraZeneca’s shares rose as much as 2.9% after the data release, before paring gains. When AstraZeneca announced it had licensed the once-daily pill, called AZD5004, it said it believed the treatment could cause fewer side effects than injectable treatments such Eli Lilly’s (LLY.N), opens new tab Zepbound and Novo Nordisk’s (NOVOb.CO), opens new tab Wegovy.

One of the Phase II trials of the drug, will focus on reduction in body weight in obese and overweight participants and is expected to be completed by the end of 2025, Barr said.

“We saw a dose-dependent increase in nausea and vomiting consistent with molecules in this class,” Barr told a briefing, referring to GLP-1 receptor agonists, which slow digestion and reduce hunger. Zepbound and Wegovy are both from this class.

There were no serious adverse events reported, she said.

CEO Pascal Soriot acknowledged after the Eccogene deal that AstraZeneca was “a few years behind” Novo Nordisk and Eli Lilly who were first to market with highly effective obesity drugs.

The drugmaker is now bullish for its obesity business.

Its weight-loss pill compares favourably to others in clinical development by rival companies because it is a small molecule that can be combined with other small molecule drugs, said Barr, which is important because more than 60% of obese and overweight people have one or more other medical conditions.

The pill can be taken with or without food, Barr added, citing data released from an early-stage trial of 14 patients.

AstraZeneca also released data from Phase I trials of its other leading experimental obesity drugs, which are injected.

One, AZD6234, targets a pancreas hormone called amylin that affects hunger. Another, called AZD9550, targets the gut hormone GLP-1 and a second obesity-related hormone called glucagon.

Trials showed both were safe and tolerable, AstraZeneca said, adding it had begun Phase II trials in overweight and obese patients for AZD6234 and expects to complete in 2026. It will start them for AZD9550 in the next six months.

Meanwhile, Viking Therapeutics (VKTX.O), opens new tab on Monday published results from an early-stage trial of its oral obesity treatment that analysts said compared well to rivals in development.

Credit: Reuters

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Popular weight-loss drug Wegovy maker Novo Nordisk (NOVOb.CO) expects high demand and acceptance for its anti-obesity drug, when launched in India, a top executive said.

The company is still “evaluating” the price of the drug, but is confident that the price-sensitive Indian population will be able to afford it, Novo’s India Managing Director Vikrant Shrotriya said.

“It is going to be a very promising launch in India where the acceptance of the medication is going to be higher than what we have seen in many of the other therapy areas,” Shrotriya said.

Government intervention is necessary to raise awareness among the larger Indian population about obesity being a chronic disease, Shrotriya said on Wednesday, while presenting a 2022 Novo-funded study on India’s obesity market.

The Danish drugmaker’s blockbuster drug Wegovy and related diabetes drug Ozempic belong to a class of therapies known as GLP-1 receptor agonists that help control blood sugar and slow digestion, making people feel fuller for longer.

Boxes of Wegovy move along a packaging line at Novo Nordisk’s facility in Hillerod, Denmark, March 8, 2024. REUTERS/Tom Little//File Photo

Soaring global demand for these drugs, including U.S. rival Eli Lilly’s (LLY.N), opens new tab Zepbound and Mounjaro, has made the companies among the world’s valuable as they aggressively compete in a global weight-loss market that some analysts predict could reach $150 billion in the next decade.

Novo, which last year told Reuters about plans to launch Wegovy in India in 2026, refused to comment on if it was on track for the same, adding the company has some “reservations about it at this point of time” given the global demand has surpassed their production capacity.

“There are (other) countries in the list for launch,” he said.

Lilly plans to launch its obesity drug in India by next year. Both companies are expected to face competition from Indian drugmakers who are developing generic versions of weight-loss drugs for the global and price-conscious Indian market.

Credit: Reuters

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Novo Nordisk (NOVOb.CO), opens new tab said the side effects in trials so far for its experimental obesity drug CagriSema were similar to its GLP-1 drugs already on the market, and reiterated its expectation the new injection will deliver 25% weight loss.

Martin Holst Lange, Novo Nordisk’s head of development, made the comments to Reuters after the company released better-than-expected third-quarter results.

The Danish drugmaker is due to release data from a late-stage trial of CagriSema, a two-drug combination obesity treatment that, like its popular obesity drug Wegovy, is injected, by the end of 2024.

CagriSema targets the same gut hormone as Wegovy does, but also targets a pancreas hormone called amylin.

Novo Nordisk has previously said that CagriSema has a potential of up to 25% weight loss, compared with the 15% weight loss of Wegovy.

Flags with the Novo Nordisk logo flutter outside their Danish company’s offices in Copenhagen, Denmark. REUTERS/Tom Little/File Photo

Lange said on Wednesday the company still expects the data from its Phase 3 trial to reflect this higher weight loss.

“No change in our confidence level,” he said.

Analysts view this data as “a must-win” for Novo’s obesity-driven investment case, given the hot competition among pharma companies to deliver higher weight loss than Wegovy and Zepbound, the rival obesity injection that U.S. company Eli Lilly (LLY.N), opens new tab launched last year.

Novo’s share price could go up to 20% higher or lower depending on it, predict ABG Sundal Collier analysts.

Lange said that Novo needed to collect more data on the psychiatric side effects of another experimental obesity treatment, monlunabant, in a Phase 2b trial before it could progress to a Phase 3 or late-stage trial.

The company’s shares fell nearly 5% in September after results from a Phase 2a trial of monlunabant, a pill, came in below market expectations. Novo acquired the drug last year as part of its $1 billion purchase of Canadian biotech firm Inversago Pharmaceuticals.

Novo had already planned to conduct a Phase 2b trial even before it got the data from the latest trial, Lange said, but the Phase 2a trial did reveal new psychiatric side effects and suggests that perhaps excessively high dose strengths were tested. The new trial will involve a lower-dose strength, he said.

Credit: Reuters

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Novo Nordisk (NOVOb.CO), opens new tab is lifting curbs on prescriptions of its weight-loss drug Wegovy in the United States and is increasing supply in that market, its CEO said on Wednesday.

“In our guidance for the full year, you can assume that there is a step up in the fourth quarter and that’s partly driven by increased products including Wegovy into the U.S.,” Lars Fruergaard Jorgensen told Reuters in an interview.

Boxes of Wegovy move along a packaging line at Novo Nordisk’s facility in Hillerod, Denmark, March 8, 2024. REUTERS/Tom Little/File Photo

He said that the slower pace of weekly prescriptions for Wegovy in the United States in the last couple of months was due to lower starter doses being supplied into the market.

“You can find different periods of times where you can say it’s plateauing but it’s not because of plateaued demand, it’s simply because of the supply into the market,” Fruergaard said.

Credit: Reuters

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New research highlights the potential for weight-loss medication to ease arthritis symptoms, offering hope for improved mobility and pain relief. 

In a recent study published in The New England Journal of Medicine, researchers used a 68-week-long, extensive (61 centers across 11 countries), randomized clinical trial to evaluate Semaglutide’s pain- and weight-relieving performance in overweight arthritis patients.

A once-weekly 2.4 mg subcutaneous injection of the novel antidiabetic wonder drug was observed to reduce body weight (13.7%) and pain (WOMAC = 41) substantially more than similar placebo dosages (3.2% and 27.5 points, respectively).

Semaglutide consumption almost doubles physical function gains compared to placebo (12.0 versus 6.5 points), further promoting somatic health, weight loss, and healthy aging. Safety was similar between case (Semaglutide) and control (placebo) cohorts.

Together, these findings add yet another feather in Semaglutide’s growing cap of notable achievements, underscoring the drug’s potential to replace conventional pharmacological interventions not only in treating excessive body weight and diabetes but also associated conditions without added side effects over existing antidiabetic modalities.

Background

Arthritis is an umbrella term for several diseases characterized by painful and often debilitating inflammation in joints and connective tissues between adjoining bones. Osteoarthritis of the knee (OK) is the most common of these conditions, causing patients substantial pain, impaired mobility, and significantly reduced quality of life.

Several risk factors associated with OK genesis and progress have hitherto been identified, with obesity (excessive body weight) highlighted as a major contributing to the disease. High body mass index (BMI) has been shown to increase joint inflammation, exacerbating pain. Studies have elucidated that weight reductions following arthritis onset can noticeably improve pain and stiffness outcomes.

Conventional weight loss clinical interventions have historically helped improve short-term Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Unfortunately, with bariatric surgery representing a notable exception, most conventional weight loss modalities (dietary- and physical activity-based interventions) are found to provide highly patient-specific, short-term weight benefits that rarely persist for more than a few months and may involve significant alternations to patients’ daily routines.

Despite almost guaranteeing positive weight loss outcomes, bariatric surgery is an extensively invasive procedure with potential adverse side effects, making it a ‘last-case scenario’ in severe obesity. Unfortunately, today’s prevalent lifestyle (sedentary) and dietary choices (suboptimal diets such as the Western Dietary Pattern) are driving an unprecedented escalation in obesity incidence, underscoring the need for safe, long-lasting, efficient, and non-surgical interventions that both obesity-induces OK pain and addresses excessive body weight.

Study: Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis. Image Credit: Jo Panuwat D/Shutterstock.com

About the study

The present study leverages a placebo-controlled clinical trial methodology to elucidate the potential application of Semaglutide, a recently developed antidiabetic drug, in treating weight-associated knee osteoarthritis.

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist belonging to the incretin mimetic class. The drug has been extensively validated in obese/overweight and diabetic cohorts, with subcutaneous (usually 2.4 mg) injections administered weekly demonstrating generation-defining gains in long-term weight loss and diabetes management at reduced side-effect costs (compared with conventional pharmacological interventions).

While the benefits of weight management for OK pain relief have been previously established, the efficacy and safety of the drug in elderly OK patients remain unknown.

The study cohort was derived from the Semaglutide Treatment Effect in People with Obesity (STEP) 9 trial, a multicentre (61 sites across 11 countries) long-term Semaglutide assessment adopting double-anonymized, randomized, placebo-controlled study methodologies. Adult STEP participants (>18) presenting clinically validated OK and reporting WOMAC scores >40 (100-point scale) were included and randomized into cases and controls (2:1 ratio).

Experimental procedures included weekly intervention administrations (2.4 mg Semaglutide and equivalent placebo injections) alongside guidance on physical and dietary interventions that may improve weight- and/or OK outcomes. Outcomes of interest were reductions in BMI, WOMAC pain scores, or stiffness following 68 weeks of consistent intervention.

Study findings

Out of the thousands of STEP 9 trial participants, 407 met the study inclusion criteria and were assigned to the case (n = 271) and control (n = 136) cohorts. A majority of participants were female (81.6%), belonging to the White ethnicity (60.9%), and having a mean BMI of 40.3 kg m-2 (obesity is usually diagnosed using BMI ≥30 as a cutoff).

Study findings highlight Semaglutide’s performance, with the drug inducing a 13.7% decrease in BMI and a 41.7 point reduction in WOMAC scores in case-cohort members. In contrast, in tandem with dietary and physical activity advice, the placebo resulted in only 3.2% and 27.5 point reductions in placebo cohort members. Secondary endpoint analysis validated these findings and revealed that Semaglutide consumption almost doubled SF-36 physical-function scores (12.0 versus 6.5), underscoring its vast biological influence and multiorgan benefits.

Safety assessments presented statistically similar findings across both cohorts—10.0% of cases and 8.1% of controls reported adverse side effects (the most common being gastrointestinal tract distress). Severe adverse effects (requiring study discontinuation) were reported in 6.7% of cases and 3.0% of controls. These findings demonstrate that Semaglutide substantially outperforms placebos in excessive weight reduction, resulting in a cascade of OK benefits.

Conclusions

The present study provides clinical evidence for the knee arthritis-relieving benefits of Semaglutide compared to conventional pharmacological interventions against excessive BMI and its OK-associated outcomes (primarily pain and stiffness).

Study findings highlight that Semaglutide can achieve more than 10% additional weight loss compared to current non-surgical interventions, resulting in substantial 41.7-point pain reductions in OK patients.

While present, semaglutides’ side-effect inducting potential is comparable to conventional modalities. Together, these findings highlight Semaglutide as a safe and efficient means of promoting weight loss and reducing chronic pain in OK patients.

Credit: news-medical.net

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Semaglutide linked to 40-70% lower risk of first-time Alzheimer’s diagnosis in type 2 diabetes patients compared to other antidiabetic medications. 

A recent Alzheimer’s and Dementia study uses real-world data in the United States to evaluate the protective role of semaglutide against Alzherimer’s disease (AD).

Could semaglutide prevent AD?

In 2014, approximately 6.9 million American citizens 65 years of age and older were diagnosed with AD, with the prevalence of this disease predicted to reach 13.8 million by 2060. Although there is no cure for AD, several modifiable risk factors have been identified that can be targeted to reduce or delay the onset of both AD and dementia.

Study: Associations of semaglutide with first-time diagnosis of Alzheimer’s disease in patients with type 2 diabetes: Target trial emulation using nationwide real-world data in the US. Image Credit: Marc Bruxelle/Shutterstock.com

The U.S. Food and Drug Administration (FDA) has approved semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA), to treat type 2 diabetes mellitus (T2DM) and obesity.

In addition to these indications, semaglutide can also support the management of various health conditions, including cardiovascular disease, depression, alcohol use, and smoking, all of which are also considered modifiable risk factors for AD. Thus, clinical trials are needed to assess whether semaglutide can delay or prevent AD.

About the study

The researchers of the current study hypothesized that semaglutide reduces the risk of developing AD in high-risk patients. To this end, an emulation target trial was conducted using the TriNetX Analytics platform based on real-world electronic health records (EHRs) of T2DM patients without a history of AD.

Seven target trials were emulated using 1,094,761 eligible patients from a nationwide database of U.S. patients. All study participants, both men and women, were 60 years of age or older.

None of the study participants used any antidiabetic medications within the past six months of the study commencement and were considered ‘new users.’  However, these patients received semaglutide prescriptions due to a history of hypertension, obesity, hypercholesterolemia, heart disease, or stroke.

For every patient population, a specified trial was conducted to compare semaglutide with other drugs used to treat T2DM including sodium-glucose cotransporter-2 inhibitors (SGLT2i), insulins, metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), dipeptidyl-peptidase-4 inhibitors (DPP-4i) and other GLP-1Ras.

Based on EHR data, the first-time diagnosis of AD was considered the primary outcome, whereas AD-related medication prescriptions, such as donepezil, lecanemab, rivastigmine, aducanumab, memantine, and galantamine, were considered secondary outcomes. Each outcome was separately analyzed.

Study findings

The study cohort consisted of 17,104 new users of semaglutide and 1,077,657 new users of other antidiabetic medications. The effectiveness of semaglutide was compared with each of the studied antidiabetic medications.

Significant heterogeneity was observed between insulin and semaglutide recipients regarding ethnicity, age, sex, diagnosis of obesity, certain cardiovascular conditions, and AD-related risk factors. However, these groups were balanced after matching their propensity score.

T2DM patients who were prescribed semaglutide were significantly less likely to be diagnosed with AD during a three-year follow-up visit as compared with those prescribed other antidiabetic medications, irrespective of sex, gender, and obesity. The overall three-year risk of first-time AD diagnosis was almost two-fold higher in the general older population.

The three-year cumulative incidence curves comparing semaglutide with each antidiabetic medication indicated a divergence in the curve within 30 days that continued to separate thereafter. This finding highlights the role of semaglutide in delaying AD development with persistent effects.

Similarly, the subpopulation analysis indicated that semaglutide reduced the risk of first-time AD diagnosis as compared to other antidiabetic medication groups. The secondary outcomes analysis also indicated that semaglutide decreased AD-related medication prescriptions as compared to other antidiabetic medications in diabetic patients, with or without obesity.

How does semaglutide protect against AD?

Existing evidence suggests that GLP-1RAs like semaglutide may protect cognitive function by increasing authophagy and brain glucose uptake. Preclinical studies have also demonstrated that semaglutide can reduce neurotoxicity by preventing the proliferation of amyloid β (Aβ) plaques and tau tangles.

Clinical studies have produced similar results, with GLP-1RAs reducing cognitive impairment in patients with T2DM. In fact, one study conducted in Denmark found that patients with T2DM prescribed GLP-1RAs were at a 53% reduced risk of developing all-cause dementia.

Importantly, several other diabetic medications, including SGLT2i, may also reduce the risk of first-time AD diagnoses. SGLT2i, for example, reduces neuroinflammation, oxidative stress, and mitochondrial dysfunction. Nevertheless, the current study reports that semaglutide was significantly more protective against AD than other anti-diabetic medications, including SGLT2i.

Despite these observations, additional research is needed to elucidate the mechanisms through which semaglutide reduces the risk of developing AD.

Study limitations

The current study has several limitations, including the retrospective observational study design that used patient EHRs. This study design may not consider overdiagnoses, underdiagnoses, misdiagnoses, and unmeasured or uncontrolled confounders, which could generate biased results.

Furthermore, since semaglutide received FDA approval relatively recently, the follow-up period was limited to only three years.

Patient data was obtained from the TriNetX Analytics platform; therefore, the results require additional validation in analytics platforms. EHRs in TriNetX lack data on medication adherence and cognitive impairment tracking, which may influence study outcomes.

Conclusions

Semaglutide prescription reduced the risk of a first-time AD diagnosis by 40-70% in older populations with T2DM and other comorbidities.

Future studies are needed to investigate the effectiveness of this drug in other populations. The effect of semaglutide in mild cognitive impairment and other neurodegenerative diseases should be investigated.

Credit: news-medical.net

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Weight-loss and diabetes drugs like Ozempic, Wegovy, Mounjaro or Zepbound appear to help people battle alcoholism and opioid addiction, a new study finds.

People taking this class of drugs, called glucagon-like peptide-1 receptor agonists (GLP-1), have a 50% lower rate of drunkenness than people with addiction disorders not on the meds, researchers reported Oct. 17 in the journal Addiction.

GLP-1 patients also have a 40% lower rate of opioid overdose, results show.

GLP-1 drugs “exhibited a strong protective association with alcohol intoxication among those with alcohol use disorder,” concluded the research team led by Fares Qeadan, an associate professor of biostatistics at Loyola University in Chicago.

“Related prescriptions additionally displayed a strong protective association with opioid overdose among individuals with opioid use disorder,” the researchers added in a journal news release.

Key Takeaways

• Weight-loss drugs might help people battle addictions
• Alcoholics taking GLP-1 drugs had a 50% lower rate of intoxication
• Opioid users taking the drugs had a 40% lower risk of overdose

Credit: Adobe

GLP-1 drugs promote weight loss by mimicking a hormone produced in response to eating. Taking the drug helps stabilize blood sugar levels, decrease feelings of hunger and slow digestion, researchers noted.

The brain region targeted by GLP-1 “overlaps with the same processes that are responsible for the development and maintenance of addictive behaviors such as chronic substance use,” the researchers said.

For this study, researchers analyzed data on more than 500,000 people with a history of opioid addiction and 817,000 with a history of alcoholism. The data, drawn from 136 U.S. health systems, spanned January 2014 to September 2022.

Researchers tracked these folks’ use of GLP-1 drugs, as well as any bouts of intoxication or overdose they experienced.

“This study may introduce a promising new treatment for substance use disorders,” researchers said.

Credit: healthday.com

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Decisions on how these drugs will be used look likely to shape our future health and even what our society might look like.

And, as researchers are finding, they are already toppling the belief that obesity is simply a moral failing of the weak-willed.

Weight-loss drugs are already at the heart of the national debate. This week, the new Labour government suggested they could be a tool to help obese people in England off benefits and back into work.

That announcement – and the reaction to it – has held a mirror up to our own personal opinions around obesity and what should be done to tackle it.

Here are some questions I’d like you to ponder.

Is obesity something that people bring on themselves and they just need to make better life choices? Or is it a societal failing with millions of victims that needs stronger laws to control the types of food we eat?

Are effective weight-loss drugs the sensible choice in an obesity crisis? Are they being used as a convenient excuse to duck the big issue of why so many people are overweight in the first place?

Personal choice v nanny state; realism v idealism – there are few medical conditions that stir up such heated debate.

I can’t resolve all those questions for you – it all depends on your personal views about obesity and the type of country you want to live in. But as you think them over, there are some further things to consider.

Obesity is very visible, unlike conditions such as high blood pressure, and has long come with a stigma of blame and shame. Gluttony is one of Christianity’s seven deadly sins.

Now, let’s look at Semaglutide, which is sold under the brand name Wegovy for weight loss. It mimics a hormone that is released when we eat and tricks the brain into thinking we are full, dialling down our appetite so that we eat less.

What this means is that by changing only one hormone, “suddenly you change your entire relationship with food”, says Prof Giles Yeo, an obesity scientist at the University of Cambridge.

And that has all sorts of implications for the way we think about obesity.

It also means for a lot of overweight people there is a “hormonal deficiency, or at least it doesn’t go up as high”, argues Prof Yeo, which leaves them biologically more hungry and primed to put on weight than someone who is naturally thin.

That was likely an advantage 100 or more years ago when food was less plentiful – driving people to consume calories when they are available, because tomorrow there may be none.

Our genes have not profoundly changed in a century, but the world we live in has made it easier to pile on the pounds with the rise of cheap and calorie-dense foods, ballooning portion sizes and towns and cities that make it easier to drive than walk or cycle.

These changes took off in the second half of the 20th Century, giving rise to what scientists call the “obesogenic environment” – that is, one that encourages people to eat unhealthily and not do enough exercise.

Now one in four adults in the UK is obese.

Wegovy can help people lose around 15% of their starting body weight before the benefits plateau.

Despite constantly being labelled a “skinny drug” this could take someone weighing 20 stone down to 17 stone. Medically, that would improve health in areas like heart attack risk, sleep apnoea and type 2 diabetes.

But Dr Margaret McCartney, a GP in Glasgow, cautions: “If we keep putting people into an obesogenic environment, we’re just going to increase need for these drugs forever.”

At the moment the NHS is planning to prescribe the drugs only for two years because of the cost. Evidence shows that when the injections stop, the appetite comes back and the weight goes back on.

“My big concern is the eye is taken off the ball with stopping people getting overweight in the first place,” says Dr McCartney.

We know the obesogenic environment starts early. One in five children is already overweight or obese by the time they start school.

And we know that it hits poorer communities (in which 36% of adults in England are obese) harder than wealthier ones (where the figure is 20%), in part due to the lack of availability of cheap, healthy food in those less affluent districts.

But there is often a tension between improving public health and civil liberties. You can drive, but you have to wear a seatbelt; you can smoke, but with very high taxes alongside restrictions on age and where you can do it.

So here are some further things for you to consider. Do you think we should also tackle the obesogenic environment or just treat people when it’s starting to damage their health? Should government be far tougher on the food industry, transforming what we can buy and eat?

Should we be encouraged to go Japanese (a rich country with low obesity) and have smaller meals based around rice, vegetables and fish? Or should we cap the calories in ready meals and chocolate bars?

What about sugar or junk-food taxes? What about wider bans on where calorie-dense foods can be sold or advertised?

Prof Yeo says if we want change then “we’re going to have to compromise somewhere, we’re going to have to lose some liberties” but “I don’t think we’ve come to a decision within society, I don’t think we’ve debated it”.

In England, there have been official obesity strategies – 14 of them across three decades and with very little to show for it.

They included five-a-day campaigns to promote eating fruit and veg, food labelling to highlight calorie content, restrictions on advertising unhealthy food to children and voluntary agreements with manufacturers to reformulate foods.

But although there are tentative signs that child obesity in England may be starting to fall, none of these measures have sufficiently altered the national diet to turn the tide on obesity overall.

There is one school of thought that weight-loss drugs may even be the event that triggers the change in our meals.

“Food companies profit, that’s what they want – the only ray of hope I have is if weight-loss drugs help a lot of people resist buying fast foods, can that start the partial reversal of the food environment?” asks Prof Naveed Sattar from the University of Glasgow.

As weight-loss drugs become far more available, deciding how they will be used and how that fits into our wider approach to obesity will need to be addressed soon.

At the moment we are only dipping our toes in the water. There is limited supply of these drugs and because of their huge expense, they are available on the NHS to relatively few people and for a short time.

That is expected to change dramatically over the next decade. New drugs, such as tirzepatide, are on the way and the pharmaceutical companies will lose their legal protections – patents – meaning other companies can make their own, cheaper versions.

In the early days of blood-pressure-lowering medicines or statins to reduce cholesterol, they were expensive and given to the few who would benefit the most. Now around eight million people in the UK are taking each of those drugs.

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Prof Stephen O’Rahilly, director of the MRC Metabolic Diseases Unit, says blood pressure was tacked with using a combination of drugs and societal change: “We screened for blood pressure, we advised about lower sodium [salt] in foods and we developed cheap, safe and effective blood pressure drugs.”

That’s analogous, he says, to what needs to happen with obesity.

It is still not clear how many of us will end up on weight-loss medication. Will it only be for those who are very obese and at medical risk? Or will it become preventative to stop people becoming obese?

How long should people take weight-loss drugs for? Should it be for life? How widely should they be used in children? Does it matter if people using the drugs are still eating unhealthy junk food, just less of it?

How quickly should weight-loss medications be adopted when we still do not know the side-effects of long term use? Are we OK with healthy people taking them entirely for cosmetic reasons? Could their availability privately widen the obesity and health gap between rich and poor?

So many questions – but, as yet, few clear answers.

“I don’t know where this is going to land – we’re on a voyage of uncertainty,” says Prof Naveed Sattar.

Credit: BBC

Team Metabolic Health

Glucagon-like peptide-1 (GLP-1) agonists have taken the healthcare world by storm, emerging as mainstream treatments for patients with diabetes or obesity. Some of these medications include Novo Nordisk’s (NYSE: NVO) Ozempic, Wegovy, Rybelsus, and Saxenda, and Eli Lilly’s (NYSE: LLY) Mounjaro and Zepbound.

Below, I’ll dig into which pharmaceutical stock I think is the better buy for the long run. While Novo Nordisk and Lilly each carry encouraging prospects, I see one of these companies as the superior opportunity.

Image source: Getty Images

The case for Novo Nordisk

Right now Novo Nordisk has a considerable lead on Lilly in GLP-1 market share, and a couple of notable wins have me thinking this lead will widen.

Earlier this year, J.P. Morgan released a report outlining the potential for GLP-1 treatments in other markets. Specifically, research suggests that GLP-1 drugs have applications outside of weight loss. Such areas include sleep apnea, arthritis, kidney disease, cardiovascular disease, and Alzheimer’s.

Although becoming a multi-platform breakthrough could serve as a catalyst for both Novo Nordisk and Lilly, I think Novo Nordisk has the edge for now. Back in March, Wegovy received an expanded indication from the Food and Drug Administration (FDA) to treat obesity care patients who are also at risk of major cardiovascular events.

A few months later, Wegovy was approved to enter yet another market: China, a geographic region where obesity rates are quite high.

All things considered, I think Novo Nordisk’s momentum in the GLP-1 realm could be kicking into a new gear.

The case for Eli Lilly

To be fair, while Novo Nordisk has the lead in the GLP-1 arena, I have to note that Lilly’s Mounjaro and Zepbound have not been on the market nearly as long as its competitor’s medications have. And although Mounjaro and Zepbound have already reached blockbuster status, Lilly’s own CEO admits that the company hasn’t been investing as heavily in marketing campaigns for these medications as it could be.

I see this as a strategic move on Lilly’s end; it seems the company is content taking its time building a presence in the market, and is not in a rush to oversell its products. Such patience could be a wise move in the long run as Mounjaro and Zepbound become more popular.

Where Eli Lilly starts to really separate itself from Novo Nordisk is in other markets. For example, over the summer Lilly’s Alzheimer’s drug received approval from the FDA. More recently, the company also received the nod to enter the eczema market via its newly approved drug Ebglyss.

Lastly, Lilly is making some interesting moves relating to the use of artificial intelligence (AI) in the healthcare world. The company is working with OpenAI to help develop new medications to combat antimicrobial resistance (AMR).

The bottom line

At a high level, both Novo Nordisk and Eli Lilly appear to have strong road maps ahead. But thinking long-term, I see Lilly as the clear-cut winner. Novo Nordisk’s position as ruler of the GLP-1 realm should eventually normalize as Lilly gains more market share and other potential players enter the space as well.

Beyond weight loss treatments, Lilly has some billion-dollar opportunities both with its Alzheimer’s and eczema medications, and in the use of AI in drug development — but none of these efforts have started bearing fruit for the company yet.

For me, Lilly’s diverse platform compared to Novo Nordisk’s is attractive, and I’m confident that Eli Lilly has more upside potential than its competition does.

Credit: Yahoo

Team Metabolic Health

Novo Nordisk (NOVOb.CO), opens new tab said on Friday its weight-loss drug met the main goal of a late-stage trial in patients with a type of fatty liver disease by reducing scarring of the organ without worsening the condition.

The study used 2.4 milligram dose of semaglutide to treat a liver condition called metabolic dysfunction-associated steatohepatitis, or MASH, in one part of the trial involving 800 patients.

Semaglutide is sold as Wegovy for weight-loss and Ozempic for diabetes.

Boxes of Wegovy made by Novo Nordisk are seen at a pharmacy in London, Britain. REUTERS/Hollie Adams/File Photo

At 72 weeks, 37% of patients on the drug showed improvement in liver scarring, with no worsening of steatohepatitis, an inflammation of the organ due to excess fat deposits, compared with 22.5% of those on placebo.

In the trial, 62.9% of those on the drug also achieved resolution of steatohepatitis compared with 34.1% on placebo.

MASH, which was earlier known as NASH or non-alcoholic steatohepatitis, affects around 5% of adults in the U.S., according to the American Liver Foundation, making it a large patient population.

But Madrigal Pharmaceuticals’ (MDGL.O), opens new tab Rezdiffra is the only approved treatment.

“The long-term perspective paints a positive picture as large pharma has resources to substantially grow this market to create an even larger opportunity for Rezdiffra,” said Piper Sandler analyst Yasmeen Rahimi.

Shares of Novo Nordisk rose 1% in Copenhagen, while Madrigal added 22% in New York. Drug developer Akero Therapeutics (AKRO.O), opens new tab rose 5%.

Novo’s drug showed a 14.5% difference between improvement in fibrosis after adjusting for the placebo, compared to 12% shown by 100 mg dose of Rezdiffra in a separate late-stage trial, opens new tab.

Lilly’s tirzepatide – the active ingredient popular diabetes drug Mounjaro and weight-loss drug Zepbound – helped up to 74% of patients achieve absence of the disease with no worsening of scarring in a mid-stage trial.

Jefferies analyst Peter Welford expects Wegovy to generate $2 billion at the peak of its sales outside of obesity from MASH patients.

Novo Nordisk expects to file for regulatory approvals in the U.S. and the European Union in the first half of 2025.

Novo and Lilly are also testing their weight-loss drug for several other conditions, including Alzheimer’s disease.

Credit: Reuters

Team Metabolic Health

In a practice-changing guideline reversal, medical societies advised, opens new tab on Tuesday that most patients do not need to stop taking GLP-1 diabetes and weight-loss drugs before surgery, a ruling supported by a study presented this week at a medical meeting of gastrointestinal doctors.

The study also suggests that patients might benefit from following a clear liquid diet for a day in advance, although that was not included in the new guidelines.

Patients typically fast before undergoing anesthesia in order to empty the stomach. An empty stomach allows for better examination via endoscopy and lowers the risk of aspiration, a life-threatening complication involving inhalation of gastric contents.

Because GLP-1 drugs such as Novo Nordisk’s (NOVOb.CO), opens new tab Ozempic and Wegovy and Zepbound and Mounjaro from Eli Lilly (LLY.N), opens new tab slow stomach emptying, surgeons had been requiring patients to stop those drugs well in advance of anesthesia in order to ensure an empty stomach.

But a new review of 35 studies involving more than 714,000 patients undergoing upper-gastrointestinal endoscopy found no extra risk of aspiration in patients who had not paused their use of GLP-1 drugs beforehand.

Boxes of Ozempic and Wegovy made by Novo Nordisk are seen at a pharmacy in London, Britain. REUTERS/Hollie Adams 

They were compared with patients who either were not using the drugs or were using them but had stopped them well in advance of surgery.

The findings were presented by Dr. Violeta Popov of NYU Langone Health NY VA Harbor Health System on Wednesday at the American College of Gastroenterology, opens new tab meeting in Philadelphia.

Procedures more often had to be stopped early in patients who had not stopped the GLP-1 drugs, possibly because significant amounts of food remained in the stomach, her team found. However, retained gastric contents were not a problem in a subset of patients taking GLP-1 drugs who had been on a liquid diet for 24 hours because they were scheduled for colonoscopy.

Therefore, the researchers suggest, it might be best to follow a 24-hour clear liquid diet prior to GI endoscopy without discontinuing GLP-1 therapy.

Esophagus cancer precursor being seen at younger ages

A pre-malignant condition of the esophagus is becoming more common at younger ages, researchers have found, suggesting potential benefits from earlier screening.

Barrett’s esophagus is usually diagnosed around age 60, but a new study of more than 2.6 million patients found a significantly increasing trend of young-onset Barrett’s esophagus from 2014 to 2023, researchers reported at the gastroenterology meeting.

In Barrett’s esophagus, stomach acid has damaged the lining of the lower esophagus, increasing the risk for cancer.

Treatment may include medicines and surgery. Patients with mild cases are advised to undergo endoscopy on a regular basis to monitor the cells in the esophagus lining.

In the new study, 20% of participants had been diagnosed before age 50, with early-stage disease in nearly all cases.

Risk factors in younger patients were similar to those in older patients, including hiatal hernia, gastrointestinal reflux, smoking, and high body mass index, Dr. Anila Vasireddy of the University of Pennsylvania Health System reported.

“Our study validates that conventional risk-factors of Barrett’s esophagus in older patients also predict young-onset Barrett’s esophagus,” her team said in a written summary.

“Screening… before the age of 50 may have a significant impact on early detection of esophageal adenocarcinoma,” they said.

U.S. patients undertreated for alcohol use disorder

Drug treatment of alcohol use disorder is underused in U.S. patients and particularly in patients with alcoholic liver disease, researchers reported at the Philadelphia gastroenterology meeting.

Pharmacotherapy is an important tool for treating addiction and preventing progression of liver disease. But among 26,985 commercially insured patients with alcohol use disorder who did not have liver disease, only 14.5% had been prescribed medication. That rate dropped to 2.3% among 1,201 alcohol abuse patients with liver disease, the researchers said.

Patients with the most severe alcoholic liver disease had the lowest odds of receiving drug therapy for their alcoholism, Dr. Alex Jones of the University of Texas Southwestern Medical Center reported.

Gabapentin was the most commonly prescribed medication in the study, followed by oral naltrexone and topiramate.

“Providers caring for patients with alcoholic liver disease should consider this underutilized therapy, or refer for psychiatric consultation when appropriate,” the researchers said.

Credit: Reuters

Team Metabolic Health

Teva described the EU regulator’s decision as “extreme, untested and factually unsupported.”

The European Commission has hit the world’s largest maker of generic drugs with a €462.6 million fine for breaching the bloc’s competition rules.

It is the first time in the history of the EU’s antitrust division that a company has been fined for misusing the EU patent system and systematically disparaging rivals.

In a statement posted to its website, Teva, an Israel-headquartered multinational, described the decision as being underpinned by “extreme, untested, and factually unsupported” legal theories. Noting that the company was “well prepared financially to mount a defense,” it said it would appeal the decision.

Credit: olrat/Adobe Stock

Teva described the EU regulator’s decision as “extreme, untested and factually unsupported.”

The European Commission has hit the world’s largest maker of generic drugs with a €462.6 million fine for breaching the bloc’s competition rules.

It is the first time in the history of the EU’s antitrust division that a company has been fined for misusing the EU patent system and systematically disparaging rivals.

In a statement posted to its website, Teva, an Israel-headquartered multinational, described the decision as being underpinned by “extreme, untested, and factually unsupported” legal theories. Noting that the company was “well prepared financially to mount a defense,” it said it would appeal the decision.

“Temu takes its obligations under the DSA seriously, continuously investing to strengthen our compliance system and safeguard consumer interests on our platform,” the company added in a statement sent to Law.com International. “We will cooperate fully with regulators to support our shared goal of a safe, trusted marketplace for consumers.”

According to Brussels officials, the Israeli drugmaker abused its dominant position in Belgium, Czechia, Germany, Italy, the Netherlands, Poland and Spain with the goal of slowing down competition and artificially extending the exclusivity of its prize multiple sclerosis drug Copaxone. The company did this, officials said, by obstructing the market entry and the uptake of competing, lower-cost medicines that relied on the same active ingredient as Copaxone.

The EU’s Luxembourg-based General Court will rule on Teva’s appeal, which could take up to two years. Jonas Koponen, a partner in Cooley’s Brussels office, told Law.com International that patent, regulatory and marketing strategies are “normal and legitimate means of competition.” He said the EU court had made clear in its previous rulings that dominant firms are allowed to resort to “aggressive strategies,” as long as they are based on “competition on the merits” and not prone to foreclose rivals.

“If this decision is appealed, a key question for the Court would be to determine whether the conduct that the Commission found abusive amounts to “competition on the merits” in the specific context of the pharma sector,” he said. “But this is a nebulous notion, and it would be important for the Court to clarify when legitimate business strategies ‘cross the line’—a blurred line risks stifling legitimate and healthy competition.”

Another large company also has ended up in the EU’s crosshairs: EU officials have opened an investigation against Temu under the bloc’s Digital Services Act over concerns that the popular Chinese online retail platform sold illegal products and designed the service in an addictive way.

Over the next few months, the EU regulator will also look into the systems used by Temu to recommend purchases to users, as well as the data access the company has offered researchers. If Brussels officials find the company has indeed breached the bloc’s online safety law, Temu could face a fine of up to to 6% of its worldwide annual turnover.

Credit: law.com