Liraglutide 3mg is a TGA approved GLP-1 agonist to treat people living with overweight and/or obesity (PwOw/Ob). Our clinical experience in a metabolic/bariatric obesity service is that liraglutide is effective and tolerated by most PwOw/Ob, however compliance with daily dosing was variable and the cost prohibitive. Whilst semaglutide was recently TGA approved for the management of Type 2 diabetes (T2DM,) Wilding[i] showed its safety and efficacy in weekly doses of 2.4mg s/c. Aim is to determine if this once weekly preparation may provide similar weight loss in a real-world clinical setting and with greater compliance.
A retrospective analysis of EMR of 60 medical PwOw/Ob prescribed Semaglutide for weight loss at a medical/surgical bariatric clinic. An accelerated dose escalation protocol, starting with 0.25mg/week and titrated to doses up to 2.25mg/week. Demographic factors, nadir weight as adult and weight at commencement of therapy were recorded. Results, including weight loss, side effects and duration of therapy were collected.
The population weight range was between 59-148 kg and mean % total body weight-loss (%TBWL) for patients completing 3-4 months of treatment was 9.9% (range 1.3-16.9%) for a mean 8.8(0.9 – 17.4)kg weight loss. At 6-7 months weight loss was 11.6 (range 4.3-24.7) % TBWL for mean 10.7kg (3.8-19.4) kg weight loss at doses of 0.5-2mg (mean 1.13mg, median 1mg) per week. Adverse effects were minor and there were no severe adverse effects.
Semaglutide can be safely used as adjuvant pharmacotherapy for PwOw/Ob. It provides significant WL at lower doses than reported in RCT. The simplicity and affordability of a once-weekly preparation for WL and then for WL maintenance, could lead to pharmacologic adjuvants having a greater acceptance amongst PwOw/Ob, HCPs and policy makers as part of the overall chronic disease management plan.