Semaglutide (Ozempic/Wegovy): Reducing Hospitalizations

The SELECT trial has paved the way for establishing second-generation obesity medications like semaglutide (Ozempic/Wegovy) as effective tools not only for reducing blood sugar or losing weight but also for preventing “hard” health endpoints like a heart attack. Recent analyses suggest that the obesity drug Wegovy or Ozempic may also reduce hospitalizations from all causes.

A new analysis of the SELECT trial, recently written about here, indicates that patients treated with semaglutide 2.4 mg once weekly experienced:

• An 11% reduction in hospital admissions for any reason compared to those on a placebo.

• A 17% reduction in hospitalizations for cardiovascular causes, such as heart attacks and strokes.

• Significant reductions in hospitalizations for other causes, including infections and respiratory issues.

As a Licensed Naturopathic Doctor in BC working with patients with weight loss and weight related concerns for many years, I have seen first hand the benefits these medications can have, but getting insurance companies to pony up for their high price tags is challenging. I would estimate that only 20% of patients are able to be reimbursed for these medications (at this time), so any hint that obesity treatment or obesity medication might reduce future costs could be helpful for expanding access to weight management treatments into the future.

If you are interested in learning more about weight loss programs and obesity medications like Ozempic and Wegovy, feel free to reach out. Together, we can explore the best options for your health and well-being.

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To view the SELECT trial, you can see it here, and below is a short summary:

Overview of the SELECT Trial

Participants: The SELECT trial enrolled 17,604 patients who were 45 years of age or older. All participants had a body mass index (BMI) of 27 or greater, classifying them as overweight or obese. Importantly, none of the participants had a history of diabetes. Each participant also had preexisting cardiovascular disease, such as prior heart attacks, strokes, or other cardiovascular conditions.

Trial Location: The trial was multicenter and international, conducted across various locations worldwide to ensure a diverse patient population. (Note: Specific locations are not detailed in the provided abstract.)

Trial Methodology:

• Design: A double-blind, randomized, placebo-controlled, event-driven superiority trial.

• Intervention: Participants were randomly assigned in a 1:1 ratio to receive either:

  • Semaglutide 2.4 mg administered once weekly via subcutaneous injection.

  • A matching placebo injection.

• Primary Endpoint: The main outcome measured was a composite of:

  • Death from cardiovascular causes.

  • Nonfatal myocardial infarction (heart attack).

  • Nonfatal stroke.

• Analysis: Time-to-first-event analysis was used to evaluate the occurrence of these cardiovascular events.

• Safety Assessments: Adverse events and safety concerns were closely monitored throughout the study.

Results:

• Follow-Up Duration: Participants were followed for an average of 39.8 months (approximately 3.3 years).

• Primary Outcome:

  • Semaglutide Group: 569 out of 8,803 patients (6.5%) experienced a primary cardiovascular event.

  • Placebo Group: 701 out of 8,801 patients (8.0%) experienced a primary cardiovascular event.

  • This represents a 20% relative risk reduction in the semaglutide group (hazard ratio of 0.80; 95% confidence interval, 0.72 to 0.90; P<0.001), indicating statistical significance.

• Adverse Events:

  • Discontinuation Rates: Higher in the semaglutide group, with 16.6% discontinuing due to adverse events compared to 8.2% in the placebo group (P<0.001).

  • Common side effects were consistent with the known safety profile of semaglutide, often related to gastrointestinal issues.

Conclusions:

• Efficacy: Semaglutide 2.4 mg administered once weekly was superior to placebo in reducing major adverse cardiovascular events in overweight or obese patients without diabetes but with established cardiovascular disease.

• Significance: This is notable because it demonstrates cardiovascular benefits of semaglutide independent of its glucose-lowering effects, extending its potential use to a broader patient population concerned with cardiovascular risk.

• Implications for Treatment: The findings support the consideration of semaglutide as part of a comprehensive approach to reduce cardiovascular risk in patients with overweight or obesity.

Funding and Registration:

• The trial was funded by Novo Nordisk, the manufacturer of semaglutide.

• Clinical Trial Registration: SELECT ClinicalTrials.gov number, NCT03574597.

Note: The SELECT trial is a significant step in understanding how obesity medications like semaglutide can have benefits beyond weight loss, specifically in reducing serious cardiovascular events. This has important implications for healthcare providers and patients seeking effective strategies to manage weight and reduce cardiovascular risk.

Ryan Oughtred, Weight Loss Doctor in Vancouver