“If it seems too good to be true, it probably is,” became idiomatic because it’s true – I couldn’t name an exception. That is, until the creation of GLP-1 (glucagon-like peptide 1) drugs, better known as Ozempic or Mounjaro.
There is also a rapidly expanding pharmaceutical armamentarium of these semaglutide-type drugs. Although developed for the treatment of diabetes, unexpected (and important) benefits of their use are emerging, such as their effects on the heart and kidneys.
These synthetic compounds are facsimiles of a natural hormone that stimulates the production and release of insulin, slows digestion, blunts appetite, and decreases an individual’s excessive thoughts about food. These effects of the hormone, or its drug form, can be associated with weight loss. Some of the serendipitous benefits include:
- Reducing or delaying heart disease.
- Reducing the risk of stroke.
- Reducing or slowing the development of chronic kidney disease.
- Addiction management.
- An association with fertility.
Chronic kidney disease
Thirty-seven million adults in the United States have CKD. That’s more than one in seven people nationwide. Most are undiagnosed. After CKD develops, there is no cure. The management strategy is to try to stall the inevitable kidney failure. At that stage, a patient goes on dialysis or waits for a kidney transplant. Ninety percent of patients, however, die before receiving a transplant.
Recent studies in patients with Type 2 diabetes, treated with GLP-1 type drugs, showed improvement in kidney function. The drugs were so effective that the study was stopped early so all the patients could get the drug; it would have been unethical to continue withholding it from participants who were taking a placebo.
Heart disease and stroke
About six million adults in the U.S. are living with heart failure. In studies in which semaglutide-type drugs were administered to patients with heart failure, the patients reported improvement in quality of life, and they had less generalized inflammation.
Generalized inflammation is associated with heart failure. Early, small studies show promise that larger studies will demonstrate fewer hospitalizations and deaths. Some benefits may be due to weight loss. Whatever the mechanism of improvement, the drug treatment is effective.
The semaglutide drug Wegovy, initially approved for the treatment of obesity, also reduces the risk of heart attack and stroke in patients with obesity and heart disease. Wegovy is now approved for those uses as well.
Addiction
People who have struggled with alcohol and illicit opiate misuse, as well as smokers (up to two packs of cigarettes per day), when treated with GLP-1 drugs, report that they have less desire to use any addictive substance. Some patients said that cravings for their substance misuse vanished. It is thought that the part of the brain that is responsible for food cravings overlaps with the part of the brain that is responsible for cravings for substances of abuse.
The effects of the drug may offset the weight gain associated with smoking cessation, which was problematic because the weight gain increases the risk for Type 2 diabetes and other weight-related disorders.
Fertility
Some women who have struggled with infertility for years, who received Ozempic or Mounjaro, have become pregnant. More research is necessary to discern the link between GLP-1 agonists and pregnancy. This surprising occurrence is so frequent, however, that “Ozempic babies” has become a trending phrase.
The effects of these drugs on pregnancy are unknown. It’s important for patients to talk with their doctors about contraception or plans for becoming pregnant.
The GLP-1 type drugs, developed for the management of Type 2 diabetes, are creating excitement about their use for disorders resistant to treatment or for which limited treatments are available, such as addiction and infertility. The scope of their use remains to be seen. Great care, however, is needed in evaluating potential risks of adverse events associated with this class of drugs.
