Addictions, Alzheimer’s, asthma – the list goes on going on.
We reported in January that semaglutide and friends, as if they weren’t popular enough, may be helpful with depression and cognition problems.
That’s the tip of a sizeable iceberg, it seems.
For those who have lost track of all the diseases and disorders these drugs may help treat, following the recent approval of Wegovy in the US to prevent heart attacks and stroke, help is at hand.
JAMA last week published a helpful rundown of the various conditions for which GLP1s offer hope.
Like a kind of angel drug, incretins are being auditioned for roles in smoking cessation and alcohol and cocaine use disorders, as well as cognition problems, depression, Alzheimer’s, Parkinson’s, chronic kidney disease, liver diseases, asthma, COPD, rheumatoid arthritis, psoriasis, diabetic retinopathy and glaucoma.
We say “angel” with some irony, as the prospect of a drug that can make a person stop smoking, binge drinking and snorting coke without even putting on weight as a side effect … well, that person sounds a little insufferable, if we’re honest.
They aren’t all sure things, of course. But it isn’t crazy to think there may be many benefits, since besides the pancreas, “GLP-1 receptors are found in the brain, fat cells, heart, liver, and other organs,” author Rita Rubin writes.
She begins with a GP who was prescribing exenatide for diabetes control and noticed her patients were quitting smoking. That led to a pilot study in which 84 non-diabetic subjects were randomised to weekly exenatide injections or placebo (all subjects received nicotine replacement and counselling). After only six weeks, 46% of the exenatide group had quit compared to 27% of the controls, who also weighed on average 2.2kg more.
Bigger studies, including one by Ozempic maker Novo Nordisk, are under way.
Alcohol applications are still a bit anecdotal, with one large snapshot study finding people on GLP1s had fewer hospital visits, alcoholism treatments and purchases of alcohol withdrawal management medications. In one randomised trial exenatide failed to beat placebo in reducing heavy drinking days, except in a subgroup who also had obesity.
One researcher undertaking various substance use trials comments that uptake of existing drugs for alcohol use disorder is very low, but GLP1s are so normalised that the stigma might be much smaller.
With Alzheimer’s again it took a sharp eye to spot a pattern. In a diabetes trial, it was noticed that patients in the semaglutide arm had less cognitive impairment and dementia. The researchers looked at databases and found less risk for cognitive impairment or dementia among people whose T2DM was being treated with a GLP1.
Animal studies are also promising, with reduced brain inflammation after a single injection – but there’s many a slip twixt mouse and human when it comes to Alzheimer’s, and human trials are slllllloooooowwww. We hope they do better than aducanumab, discontinued earlier this year after a long saga of hype and disappointment.
Chronic kidney disease – which affects 40% of people with T2DM, according to Novo – is a promising target, with one randomised trial of 3500 people finding the risk of disease progression was 24% less after five years of weekly semaglutide injections compared with placebo.
Parkinson’s evidence is so far mixed, says the JAMA paper.
The cautionary tale voice in the Back Page’s head keeps saying GLP1s must be really bad for you in some mysterious but poetically just way, to balance how good they are – but that other shoe just doesn’t seem to want to drop.
Analysts Morgan Stanley recently predicted that the Australian market for these drugs is likely to reach $160 billion a year within a decade, and around 50% higher again if the current supply constraints are overcome.
They figure that on the basis that 30% of our population has obesity while only 0.7% of the population is on Ozempic, the only one of these products currently on the PBS.
Throw in just a couple more indications, say smoking cessation and Alzheimer’s, and you can add a few tens of billions to that number.
Send story tips that are too good to be true to penny@medicalrepublic.com.au.
