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Ozempic and Wegovy: Improves Rheumatoid Arthritis Symptoms

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Positive Reports from RA Patients

A growing number of people with rheumatoid arthritis (RA) are reporting that GLP-1 drugs like Ozempic, Wegovy, and Zepbound are helping them better manage symptoms and decrease flare-ups.

Connection Between Obesity and RA

Some people report that GLP-1 anti-obesity medications like Wegovy have helped improve their rheumatoid arthritis. Body fat and higher BMIs have been associated with a higher risk of developing rheumatoid arthritis. Health experts say more research is needed to understand the connection.

Beyond Weight Loss Benefits

The weight-loss benefits of GLP-1 medications like Ozempic, Wegovy, and Zepbound are widely known. However, as more people take these medications, there appear to be other benefits, such as reducing the risk of heart disease, stroke, kidney disease, and colon cancer. Recently, anecdotal accounts have surfaced of GLP-1 medications also helping people with rheumatoid arthritis (RA) manage their pain and experience a decrease in flare-ups.

Expert Insights on GLP-1 and RA

Impact on Autoimmune Patients

“It is well established that autoimmune patients with obesity fare worse than those without. [They] have higher symptoms and less response to traditional therapies,” Dr. Elizabeth Ortiz, rheumatologist and clinical advisor at WellTheory, told Healthline. “I have seen patients lose weight and then require less immunosuppressant therapy for their condition.”

Systematic Review Findings

According to a systematic review and meta-analysis of cohort studies, there is a positive association between levels of body fat and the risk of developing RA. Additionally, higher BMI (in middle age and early adulthood) and waist circumference are associated with a higher risk of RA. Obesity has been linked to worse autoimmune and inflammatory symptoms and less favorable responses to standard therapy for RA.

Holistic Care Approach

“In addition to keeping autoimmune patients from feeling their best in the short term, the combination of obesity and autoimmunity can have a major impact on health in the long term,” Ortiz said. “Those with rheumatoid arthritis and other autoimmune diseases carry a higher risk of cardiovascular disease than those without these conditions. Our best defense against this is tight control of autoimmune inflammation and all other cardiovascular disease risk factors, such as obesity.”

Emerging “Obesity First” Approach

Potential Benefits

Dr. Fatima Cody Stanford, associate professor of medicine and pediatrics at Harvard Medical School, said reducing weight can lead to less joint pain and inflammation, improved mobility, and reduced disease activity. “Moreover, weight loss can improve overall health, reduce comorbidities such as cardiovascular disease and diabetes, and enhance the effectiveness of RA medications,” Stanford told Healthline.

Holistic Strategy

Treating obesity first to help with other conditions has been coined the “obesity first” approach. Stanford said it is an emerging and promising strategy because addressing obesity directly can have a broad range of positive effects on multiple chronic conditions. “By targeting obesity first, healthcare providers can potentially improve or even resolve associated conditions like type 2 diabetes, hypertension, and dyslipidemia,” she said. “This holistic approach recognizes obesity as a root cause rather than a consequence, aiming to improve overall patient health and simultaneously reduce the burden of multiple chronic diseases.”

Caution Against Solely Focusing on Obesity

However, Ortiz believes it is too early to take an “obesity first” approach for autoimmune disease. While a proportion of patients with autoimmunity may have positive results by solely focusing on obesity, she said this will not be the case for everyone. “The biologic triggers for any particular individual’s autoimmune disease are complex and personal, and taking an ‘obesity first’ approach without also addressing the underlying autoimmune disease may expose patients to unnecessary risk from poorly controlled inflammation,” she said.

Future of GLP-1 Drugs in RA Treatment

Need for Collaborative Treatment Plans

As the complex relationships between obesity, metabolic health, and chronic diseases deepen, Stanford said collaboration between obesity medicine physicians, endocrinologists, rheumatologists, cardiologists, and primary care providers is needed to create comprehensive treatment plans that address the root causes of these conditions. “As new therapies and strategies emerge, they offer hope for improved quality of life and outcomes for patients struggling with obesity and associated chronic diseases,” she said. “Continued research and innovation will be key in advancing these efforts and providing evidence-based care.”

Exploring Anti-Inflammatory Properties

Given the anti-inflammatory properties that GLP-1 drugs provide and their effects on the immune system, Stanford said these medications could be promising in the context of autoimmune diseases. She anticipates more research regarding their potential benefits. “Preliminary research has suggested that GLP-1s may modulate immune responses and reduce inflammation, which could benefit conditions like RA, systemic lupus erythematosus (SLE), and inflammatory bowel disease (IBD),” said Stanford. “Further research is needed to understand the mechanisms involved and to evaluate their efficacy and safety in these contexts.”

Addressing Key Questions

Ortiz agreed. She said those treating autoimmune diseases don’t want to turn to GLP-1 drugs without a better understanding of how and why autoimmune patients may benefit from them. For instance, key questions that need to be answered include:

  • What are the anti-inflammatory effects of GLP-1s, and how do they impact those with autoimmune disease?
  • What type of autoimmune disease patient would benefit from this type of treatment, and what kind of effect can be expected?
  • What is the effect of these medications on the microbiome, and how does that impact autoimmune disease?
  • How much weight loss (if any) is needed to see an impact?
  • Are the benefits of GLP-1s in RA patients solely from weight loss?

Balancing Benefits and Risks

Understanding the effects of GLP-1 drugs on a person with an autoimmune disease like RA who is not overweight or obese needs further research. “As we continue to discover [GLP-1s] biologic effects on inflammation and our immune systems and continue to accrue data in people using them for obesity and diabetes, we may find they are a useful tool against autoimmunity, aside from their impact on obesity,” said Ortiz. Any positive impact would have to be weighed against potential risks of using these medications, such as the risk of muscle loss, as muscle loss can lead to osteoporosis, a condition often associated with autoimmune diseases, she noted.

Conclusion

Overall, more time is needed to determine whether or not GLP-1 drugs can be used to control autoimmunity and inflammation in those with or without obesity and how best to utilize the medications for these purposes. “What is likely to be addressed more quickly is how these medications can be utilized as a supplement to standard autoimmune therapy to improve metabolic syndrome and decrease an autoimmune patient’s cardiovascular risk,” said Ortiz.

GLP-1 Drugs Spurs Counterfeit Concerns

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Boom in GLP-1 Drug Usage

When GLP-1 drugs for diabetes and weight loss exploded onto the scene two years ago, patients scrambled to get their hands on them. GLP-1s, which include Ozempic, Wegovy, Mounjaro, and Zepbound, are so popular that it didn’t take long for them to wind up in short supply. According to one recent survey conducted by KFF Health Tracking, as many as one in eight adults has now used a GLP-1.

Counterfeit Drugs on the Rise

The demand shows no signs of slowing down, and as a result, counterfeit GLP-1 drugs are becoming an increasingly bigger piece of the landscape—so big, in fact, that the World Health Organization (WHO) last week issued a warning to people to be wary of the fake versions. Alongside the warning, drug makers Eli Lilly and Novo Nordisk have filed lawsuits against several entities to stop selling the counterfeits.

Unregulated Sources and Risks

Med Spas and Compounding Pharmacies

“As soon as these drugs hit the market, the demand was so high that pharmacies began running out of them,” says Dr. Supriya Rao of Integrated Gastroenterology Consultants in Boston. “So med spas and compounding pharmacies began filling that gap for patients.”

A compounding pharmacy creates medicines using base ingredients, rather than dispensing the name-brand medications like Ozempic and Wegovy. Med spas, many online sources, and compounding pharmacies do not fall under the umbrella of FDA regulation, so there are no safeguards on what a patient might receive from one of these sources. “Compounded medications are essentially ‘copies’ of available medications, but they do not have the same safety, quality, and effectiveness assurances as approved drugs since these compounded versions lack FDA approval,” explains Dr. Carolyn Jasik, chief medical officer for Omada Health.

Dangers of Counterfeit Drugs

Likewise, counterfeit drugs—like what you might find at a med spa or from an online source—are unregulated. “Counterfeit drugs, no matter what, are dangerous and can lead to serious health consequences,” says Jasik. “These medications can contain toxic doses, the wrong ingredients, or no active ingredients at all. In short, you’re paying for a drug that can either harm you or is doing nothing at all.”

Some of the risks you might face with an unregulated form of GLP-1 include nausea and diarrhea, irregular blood sugar levels, and infections at the site of injection, among others.

Cost and Accessibility Issues

Often, patients are drawn to these alternative sources not just because supply of the originals is short, but also because they can be prohibitively expensive.

“Semaglutide medications are valuable and effective, but we are currently caught in a moment where the supply chain and cost can make these drugs inaccessible to much of the broader public,” says Jasik. “It’s important to note that this is a large part of what drives the development of counterfeit drugs in the first place. As a medical provider, I’m sad that this lifesaving medication is so difficult to access and that it’s come to counterfeit drugs that take advantage of people’s desires and medical needs.”

Safety Measures for Consumers

Buy from State-Licensed Pharmacies Only

As tempting as it might be to go for the cheaper alternatives on the market—or simply just to get your hands on a GLP-1 drug—the experts recommend steering clear. “Consumers should purchase medications from state-licensed pharmacies or FDA-registered outsourcing facilities to minimize the risk of counterfeit products,” says Simona Dorf, PharmD, and clinical pharmacist at First Databank. “It’s essential to verify prescriptions from licensed health care providers and avoid drugs recommended by unverified online sources or social media influencers.”

Do Your Own Research

The FDA’s BeSafeRx website is a good source of credible information to educate yourself before hitting “buy.” The site warns against websites that pose as online pharmacies, and recommends consumers only buy prescription medicines from a state-licensed online pharmacy, plus offers a location tool to find one. Additionally, it recommends talking with your doctor about any meds you purchase online.

Check the Packaging and Labels

A sure sign that you’re dealing with a fake is misspellings on the label, or poor print quality. Give each label a good going over to make sure of its authenticity. Along with those red flags, others include a missing or added word to the drug’s name. You can also do a check on the serial numbers and lot numbers by checking the FDA’s website.

Avoid Compounding Pharmacies

Rao also reminds consumers that any medication you put in your body has the potential for side effects. Those risks only grow if you’re not purchasing them from trusted sources. “Compounding pharmacies can be a slippery slope,” she says. “Depending on who is sourcing the medication, who knows what you’re getting from one day to the next. Injecting a drug from an unknown source is risky.”

Long-Term Weight Loss Advice

There are also important steps to take with regard to weight loss, whether you are using a GLP-1 medication or not, said Jasik. These include consistent self-monitoring, like weigh-ins; maintaining a balanced diet; exercises to help build lean body mass; and lifestyle programming to create a structured approach.

Whether you choose to use a weight-loss medication or not, safety should be front and center to your approach. And if the medication is part of that, even more so. “It is crucial to cross-check such information with health care providers,” said Dorf. “Awareness of the risks associated with counterfeit GLP-1 drugs and taking proactive measures can significantly protect consumers. As demand for these medications continues to grow, vigilance from both consumers and regulatory bodies is essential to ensure safety and efficacy in treating diabetes and obesity.”

‘Rice-Zempic’: A Social Media Weight Loss Trend

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Growing Popularity of ‘Rice-Zempic’

For as long as the market for weight-loss drugs like Ozempic and Wegovy has boomed, people have been on the hunt for non-prescription and cheaper alternatives. Recently, a new natural alternative called ‘Rice-zempic’ has gained popularity on social media, with users claiming it works just as well as the medications.

The Trend’s Appeal

An increasing number of people have begun drinking a beverage consisting of rice-steeped water and lime juice after viral videos claimed it can help them drop 15 pounds in just two weeks. TikTok user Alfredo Valenzuela, known as TheChorroKing, tried the trend to lose weight before a vacation. Starting at 238 pounds, he weighed 235 pounds by day three, despite not exercising that day, prompting him to ask: “Is this the miracle water?”

Expert Opinions on ‘Rice-Zempic’

Short-Lived Results

Despite Valenzuela’s initial success, experts caution that the trend doesn’t work like weight-loss injections and is unlikely to provide long-term benefits. Valenzuela himself experienced a plateau and stopped the trend after 12 days, having lost only five pounds.

Scientific Analysis

Scott Keatley, co-owner of Keatley Medical Nutrition Therapy, stated that there is no evidence to suggest that rice water has significant weight loss properties comparable to anti-diabetic medications like Ozempic. These medications mimic a hormone that controls digestion and hunger, reducing appetite and helping people feel fuller for longer.

Mechanism of ‘Rice-Zempic’

Dr. Mir Ali, medical director of MemorialCare Surgical Weight Loss Center in California, explained that soaking rice in water releases starch, a filling nutrient. While drinking starchy water may help people feel full longer than plain water, it doesn’t impact hormones the way GLP-1 analogs do. Furthermore, substituting meals with low-calorie rice water may result in weight loss due to reduced calorie intake, but experts don’t recommend replacing whole foods with this mixture.

Recipe for ‘Rice-Zempic’

Recipes for this elixir vary, but most users combine equal parts of white rice and room temperature water, letting it sit for five minutes or overnight. The rice is then drained, and the water is mixed with juice from half a lime or lemon.

Real-Life Experiences

TikTok user Olivia Dort followed a similar recipe, starting the trend for fun and to test it out. She called herself part of ‘ChorroKing’s tribe.’ Dort began the trend weighing 174.6 pounds and dropped to 169 pounds by day four.

Comparison with ‘Oat-Zempic’

Valenzuela gained popularity by following a previous trend involving blended oat water, termed ‘oat-zempic.’ Both trends rely on the theory that drinking a more satiating liquid than plain water leads to eating less food.

Long-Term Weight Loss Advice

Dr. Ali emphasized that weight loss is about burning more calories than consumed. Diets aiming for rapid weight loss often fail to produce lasting results. He advised making small, steady changes to diet and exercise, including consuming fibrous, nutrient-dense vegetables and lean proteins. Although this approach requires more patience than trends like ‘rice-zempic,’ it yields better long-term results.

U.S. Expansion and Chinese Approval Boost Novo Nordisk

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Novo Nordisk Stock Rises on China Approval of Wegovy and U.S. Expansion

U.S. Expansion and Chinese Approval Boost Novo Nordisk

Novo Nordisk saw a rise in its stock price following the approval of its weight loss drug Wegovy in China and the announcement of a $4.1 billion investment to expand its U.S. production capacity.

The new production facility will be built in North Carolina and is part of an $11 billion global expansion plan.

Novo Nordisk, headquartered in Denmark but trading on the New York Stock Exchange under the NVO ticker, experienced a 2% increase in its stock price, reaching $145 per share overnight.

The Tesla of Pharma

Novo Nordisk revolutionized the pharmaceutical industry with its development of Glucagon-Like Peptide 1 (GLP-1) agonists, typically administered via injection. Semaglutide, one of its key products, was first approved for diabetes treatment in 2017 under the brand name Ozempic and later for weight loss in 2021 as Wegovy.

These drugs have not only transformed Novo Nordisk, located in the small Danish town of Kalundborg, 60 miles west of Copenhagen, but have also significantly impacted the weight loss industry. Former market leader WW International (NASDAQ), previously known as Weight Watchers, has now become a penny stock.

Back when Ozempic was first approved, Novo Nordisk’s stock was trading at around $26 per share. Today, it has become Europe’s most valuable company by market capitalization, surpassing the Netherlands’ ASML (NASDAQ), a leading semiconductor production equipment manufacturer. Novo is also 20 times more valuable than the next largest Danish company.

Although Novo Nordisk is currently the only company in the U.S. with FDA-approved semaglutide products, it faces competition from several similar drugs in the market. The most prominent competitor is Eli Lilly (NYSE), which markets its GLP-1 drugs, tirzepatide, under the brand names Zepbound and Mounjaro.

The Expanding GLP-1 Market

The GLP-1 market was valued at $57 million in 2018 and surged to $5.7 billion by 2022. Projections indicate that it could grow to a $133 billion global market by 2030.

Future Prospects for NVO Stock

Novo Nordisk and Eli Lilly are anticipated to dominate 80% of the GLP-1 market throughout this decade. Novo’s patent on Ozempic remains in effect until 2032, ensuring its leading position in the market for years to come.

Semaglutide Reduces Kidney Disease and Cardiovascular Events in T2D and CKD Patients

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New Findings from the Landmark FLOW Clinical Trial

Significant Reductions in Kidney Disease Worsening and Cardiovascular Events

Semaglutide was associated with significant reductions in worsening kidney disease, cardiovascular events, and all-cause death compared to placebo for adults with type 2 diabetes (T2D) and chronic kidney disease (CKD), regardless of concomitant use of sodium-glucose co-transporter-2 inhibitors (SGLT-2i), according to findings from the landmark FLOW clinical trial.

The new data from the first dedicated kidney outcomes trial with a glucagon-like peptide-1 receptor agonist (GLP-1RA) was presented at the American Diabetes Association’s (ADA) 84th Scientific Sessions, June 21-24, in Orlando, Florida, and simultaneously published in Nature Medicine.

Impact of Combining Medications

CKD is common in adults with T2D, and GLP-1RAs and SGLT-2is have both been shown to reduce cardiovascular and kidney events. The effect of combining the two classes of medications, however, is unclear. In the new data from the FLOW trial, researchers analyzed the impact of semaglutide for trial participants who did and who did not receive SGLT-2is at baseline.

The FLOW Clinical Trial

Launched in 2019, the FLOW clinical trial was a global randomized, double-blind, parallel-group, placebo-controlled, superiority trial comparing the safety and efficacy of once-weekly injectable semaglutide 1.0 mg against placebo as an adjunct to standard care on kidney outcomes in a cohort of 3533 individuals with T2D and CKD.

In March 2024, topline results were announced by the manufacturer, Novo Nordisk, which showed semaglutide reduced the risk of kidney disease progression and cardiovascular-and renal-related death by 24% compared with placebo in patients with T2D and CKD.

Then in May 2024, a full readout of the data was presented at the 61st European Renal Association Congress in Stockholm, Sweden. Results showed that participants who received semaglutide experienced a reduction in progression of CKD as well as a 21% reduction in risk of renal-specific components of the primary composite outcome.

Moreover, investigators reported an 18% lower risk of major adverse cardiovascular events in semaglutide-treated participants and a reduced risk of death from any cause of 20% vs placebo.

Detailed Analysis of New Findings

For the new analysis, researchers stratified participants by concomitant SGLT-2i use. Median follow-up was 3.4 years. The primary outcome was a composite of kidney failure, at least 50% reduction in estimated glomerular filtration rate (eGFR), and kidney or cardiovascular death, according to the study abstract.

Among the 550 participants who received SGLT-2is at baseline, the primary outcome occurred in 14.4% of those in the semaglutide group compared to 13.9% of those in the placebo group (HR 1.07, 95% CI 0.69-1.67). Among the 2983 participants who did not receive SGLT-2is at baseline, the primary outcome occurred in 22.2% of those in the semaglutide arm and 24.9% of those in the placebo arm (HR 0.73, 95% CI 0.63-0.85; P < .001; P for interaction = .109), investigators reported.

Also, among participants in the SGLT-2i group, semaglutide was associated with a decreased rate of declining eGFR compared with placebo, with a difference of 0.75 mL/min/1.73 m2 per year (95% CI –0.01 to 1.5). Researchers noted that this association was similar for participants in the non-SGLT-2i group, with a difference of 1.25 mL/min/1.73 m2 per year (95% CI 0.91-1.58; P for interaction = .237).

Consistent Benefits Across Groups

The benefits of semaglutide on major cardiovascular events and all-cause death were similar regardless of SGLT-2i use (P for interaction = .741 and .901, respectively). Moreover, the benefits of semaglutide in reducing kidney outcomes were consistent in participants with and without SGLT-2i use at baseline, according to the abstract.

Future Research and Implications

“This is a patient population at high-risk of severe kidney outcomes. Despite existing treatment options, there is still a clear unmet need for this group,” presenting author Richard E. Pratley, MD, medical director of AdventHealth Diabetes Institute in Orlando, Florida, said in an ADA press release. “The findings from the FLOW trial have the potential to change the disease course of these high-risk patients and pave the way for new treatment strategies, offering hope to millions of patients globally.”

Pratley and colleagues noted that new research will be conducted in 2024 and 2025 to assess clinically relevant areas to help address the unmet needs of patients with T2D and CKD, according to the ADA press release.

Can Weight Loss Drug Ozempic Help Cut Down Alcohol Use?

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New Research Shows Impact on Addictive Behavior

Experts debate whether the study has any pointers for controlling alcohol abuse disorder

Blockbuster weight loss drugs like Ozempic and Wegovy may now reduce your craving for alcohol, according to a new study published by Nature Communications.

Researchers followed obese individuals for a year after they began taking semaglutide, the active component in both Ozempic and Wegovy, and other weight loss drugs now popular across the world.

The results showed that, compared to other drugs prescribed for weight loss, semaglutide reduces the risk of alcohol use disorder (AUD) and relapse.

Experts explain why this happens while arguing for more research before considering semaglutide as a treatment option for AUD. Many medical professionals in the US now have anecdotal evidence that their patients on semaglutide indeed stopped drinking beyond one drink.

How does semaglutide reduce alcohol craving?

Semaglutide belongs to a class of drugs called glucagon-like peptide-1 receptor agonists (GLP-1 RA) which reduce the release of the pleasure hormone dopamine.

“They don’t just work on the stomach, they touch every organ, from the heart to the brain. We have known for a long time that dopamine is the ‘pleasure’ hormone that becomes overly activated in addiction, be it addiction to food, alcohol or even video games.

GLP-1 medications reduce the release of dopamine, making previously ‘rewarding’ behaviors, like drinking in excess, far less enjoyable,” says Dr. KP Singh, Director, Endocrinology, Fortis Hospital, Mohali, and former professor, PGIMER, Chandigarh.

According to Dr. Sandeep Chhatwal, Internal Medicine Specialist, Omni Hospital, Mohali, the receptors on which Ozempic acts are also found in areas of the brain involved in both reward-processing and addiction.

Activation of these receptors may modulate neurotransmitter activity related to craving and reward-seeking behavior. “The drug, while working on regulating glucose, may act by preventing mood swings leading to addiction,” he says.

What is alcohol abuse disorder?

It is a medical term used to describe excessive consumption of alcohol. People struggling with alcoholism are often unable to quit the habit or end up relapsing later.

“The study shows that among 83,825 patients with obesity, who had never been diagnosed with alcohol abuse disorder in the past, those using injectable semaglutide had a 50 percent lesser risk of developing alcohol abuse disorder over one year.

Similarly, a 56 percent lesser risk of relapse was shown in 4,324 patients who had been diagnosed with this disorder in the past.

And since these drugs improve the secretion of insulin from the pancreas in response to food intake, thus helping in the management of both obesity and Type 2 diabetes, they seem to have many effects,” says Dr. Akanksha Gautam, DM, Endocrinology, PGIMER, and Consultant, Endocrinologist, IVY Hospital, Mohali.

Why is this study significant for other addictive behavior?

This human study confirms the animal study where researchers had shown reduced drinking and relapse rates in alcohol-dependent rodents. Dr. Singh feels current studies have a limited number of patients and are of short duration. Hence, evidence in many more patients would be needed before declaring ‘success’ and recommending this as the sole treatment.

“Nobody should recommend semaglutide for alcohol abuse disorder in isolation, but if a patient has obesity and diabetes with over-drinking as an issue, it could work there. We would also watch out for more long-term data on pancreatitis and retinopathy with these therapies before giving our final verdict,” he sums up. If results are convincing, he sees them being used to treat other ‘OCD-like tendencies’ including nail biting, online shopping, smoking, or vaping.

Unplanned Pregnancies Linked to Popular Weight-Loss Drugs Ozempic and Wegov

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Unexpected Pregnancies Reported Among Users

Injectable weight-loss and diabetes drugs Ozempic and Wegovy have become household names worldwide. However, amidst the buzz surrounding these medications, reports of a serious side effect soon surfaced. Women described unplanned pregnancies on social media, attributing their ‘Ozempic babies’ to the new drugs.

Some women report that they got pregnant while taking the birth-control pill. Others were previously diagnosed as infertile but say that they conceived after taking a course of the drugs.

Scientific Perspective on Increased Fertility

Scientists say that the reports are plausible. They have several hypotheses about why the drugs — which belong to a group known as GLP-1 agonists — boost fertility, but until more data are available, the exact mechanism remains unknown.

“We are in a data-free zone when it comes to GLP-1s and fertility and pregnancy,” says Beverly Tchang, an endocrinologist at Weill Cornell Medicine in New York.

Mechanism of GLP-1 Drugs

The GLP-1 drugs deliver a synthetic version of a naturally occurring hormone called glucagon-like peptide 1, which conveys the feeling of being full after eating. The drug binds to the same receptor as the hormone but degrades more slowly, suppressing appetite for longer.

When GLP-1 drugs were approved for weight management in the United States a few years ago, demand skyrocketed. Semaglutide — sold by Novo Nordisk as Wegovy for weight loss and already marketed under the brand name Ozempic as a treatment for type 2 diabetes — was followed by tirzepatide, a drug produced by Eli Lilly that targets GLP-1 receptors along with another type of receptor.

Company Guidelines and Recommendations

A spokesperson for Novo Nordisk said that they had not tested semaglutide in pregnant people or individuals intending to become pregnant. However, because “there are limited clinical-trial data with semaglutide use in pregnant women”, the company recommends stopping the drug two months before a pregnancy to avoid exposing a fetus to the effects of the drug.

Consequential Delays

Scientists are investigating the idea that GLP-1 might be associated with unexpected pregnancies. Overweight and obese people often experience disruptions in their menstrual cycle caused by hormonal imbalances or inflammation. “The female reproductive system is very sensitive and responsive to metabolic health, energy balance, and nutrition,” says Nicole Templeman, a cell biologist at the University of Victoria in Canada. The weight loss triggered by GLP-1 drugs might restore regular ovulation for some women.

Beyond Weight Loss

But she says the effects could also extend beyond weight loss. “GLP-1 receptors have their own effects in the reproductive system that seem to be independent of weight loss,” says Templeman.

Indeed, people on GLP-1 drugs have reported pregnancies despite taking oral contraceptives. Eli Lilly, the company that manufactures tirzepatide, advises people on oral contraceptives to use backup methods of birth control for four weeks after starting tirzepatide, or if they increase their dosage.

A spokesperson for Eli Lilly said that the company studied drug interactions as part of the standard US Food and Drug Administration (FDA) approval process. They found that tirzepatide changes the way oral contraceptives are absorbed, potentially making them less effective.

Impact on Contraceptive Effectiveness

GLP-1 drugs slow the rate at which food and medications empty out of the stomach and into the intestines, which is where oral contraceptives are absorbed into the bloodstream. Eli Lilly data for tirzepatide showed that it reduced the maximum concentration of contraceptive in the blood by up to 66% after a single dose.

“So, over half of it is gone, which is a big problem,” says Jessica Skelley, a pharmacologist at Samford University in Birmingham, Alabama. Oral contraceptives are concentration dependent: “if there is not enough of them in the body, they can’t effectively provide contraceptive benefit,” Skelley adds.

Semaglutide seemed to affect the concentration of hormonal contraception less markedly than tirzepatide did, but Skelley says it could still be an issue because the two drugs work in a similar manner.

Beyond Digestion

Outside of digestion, GLP-1 is known to have effects on other physiological systems. In 2015, Federico Mallo, an endocrinologist at the University of Vigo in Italy, and his team published a study in which they found that dosing female rats with GLP-1 stimulated the production of luteinizing hormone (LH)2. A surge in LH is known to trigger ovulation in both rats and humans. Rats given GLP-1 had increased numbers of viable offspring when compared with untreated rats.

“We are quite sure that GLP-1 receptor analogues are promoting fertility because they are able to increase the pre-ovulatory LH peak,” he says.

Although rats are not mini humans, Mallo says, they do have menstrual cycles with similar phases to those of humans. Mallo, like other researchers, was not surprised to hear about human pregnancies after GLP-1 drug use.

Recent Research Findings

Meanwhile, in a Nature Metabolism study published on 20 May 2024, a team based in China identified a species of gut bacteria that regulates natural GLP-1 production in mice. These bacteria, Bacteroides vulgatus, suppressed production of the GLP-1 hormone, disrupting ovarian function in the mice. When the researchers treated the mice with a GLP-1 drug, they began ovulating once again.

The impact of GLP-1 drugs on fertility is a “topical conversation,” says Alyse Goldberg, an endocrinologist and fertility specialist at the University of Toronto in Canada. Data from the journal JAMA suggest that young people of reproductive age are increasingly taking these drugs. Of the 162,439 people aged 18–25 who picked up a GLP-1 prescription in 2023, more than 75% were female.

“If people are losing weight and regaining ovulation, there is a risk of pregnancy if they’re not properly counseled,” she says. As for more data on the effect of GLP-1 drugs on fertility, Goldberg says, “We’re all waiting with bated breath.”

Teva GLP 1 Generic in USA

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A New Generic Option for Type 2 Diabetes Patients

Teva Pharmaceuticals, based in New Jersey and part of Teva Pharmaceutical Industries, has introduced the first generic GLP-1 agonist, liraglutide injections, to the United States market. This move marks a significant milestone as it is the first time a generic version of this drug category is available in the U.S.

Expanding Treatment Options with Generic Liraglutide

Originally marketed under the brand name Victoza by Novo Nordisk, liraglutide is approved by the FDA to enhance glycemic control in individuals with type 2 diabetes and to lower the risk of serious cardiovascular events such as myocardial infarction and stroke in patients with both type 2 diabetes and cardiovascular disease. Ernie Richardsen, Teva’s Senior Vice President and Head of U.S. Commercial Generics, stated, “By launching an authorized generic for Victoza® (liraglutide injection 1.8mg), we are providing patients with another option for this important treatment, thereby strengthening Teva’s diverse complex generics portfolio.”

Guidelines for the Use of Generic Liraglutide

Teva advises that the generic liraglutide injections are not suitable for treating type 1 diabetes and should only be used by patients aged 10 years and older who are diagnosed with type 2 diabetes. It is also recommended that this generic should not be used in combination with other drugs containing liraglutide.

Continued Growth and Interest in GLP-1 Drugs

The impact of GLP-1 agonists on healthcare continues to expand. Initially developed for diabetes treatment, these drugs have recently gained popularity for additional benefits. A notable advancement was the FDA approval of semaglutide (marketed as Wegovy by Novo Nordisk) in March, which extended its use to reducing the risk of major adverse cardiovascular events in overweight or obese patients with cardiovascular disease. This expanding role of GLP-1 drugs in treating complex health issues was highlighted when ongoing research into these medications was named the 2023 Breakthrough of the Year by the journal Science, underscoring the significant attention these developments are receiving within the medical community.

Novo Nordisk’s CEO to Testify Before U.S. Senate on Drug Pricing

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Novo Nordisk, the company behind the blockbuster weight-loss drug Ozempic, has risen to prominence as Europe’s most valuable company in 2023. However, its high U.S. prices have drawn significant scrutiny, prompting CEO Lars Fruergaard Jørgensen to volunteer to testify before the U.S. Senate.

novo_nordisk_CEO_of_Ozempic

Rising Prominence of Novo Nordisk

Novo Nordisk has soared to the mantle of Europe’s most valuable company in 2023, largely due to the success of its weight-loss drug, Ozempic. The drug has become highly popular for its effectiveness in aiding weight loss, significantly boosting Novo Nordisk’s market value.

U.S. Price Disparities

A major point of contention has been the price of Ozempic in the U.S. A Wegovy prescription, for example, costs about $1,349 per month in the U.S., compared to $140 in Germany and $92 in the U.K. These substantial markups have sparked outrage among American consumers and lawmakers.

Senate Inquiry and Testimony

Novo Nordisk’s CEO Lars Fruergaard Jørgensen has volunteered to testify before the U.S. Senate to address the significant price disparities. Originally, Novo Nordisk’s president, Doug Langa, was set to face a vote from the Senate Committee on Health, Education, Labor, and Pensions, chaired by Senator Bernie Sanders, which would have forced him to testify.

“The American people are sick and tired of being ripped off by giant pharmaceutical companies who make huge profits every year while charging us outrageous prices,” Sanders stated. He emphasized the need for Novo Nordisk to stop charging significantly higher prices in the U.S. compared to other countries.

Company’s Response

Novo Nordisk has stated that the U.S. healthcare system is partly to blame for the high prices. They argue that a significant portion of their revenues goes to middlemen, a situation not mirrored in Europe. Consequently, Novo Nordisk claims it retains only about 60% of the list price of Wegovy and Ozempic in the U.S.

Production Costs and Profit Margins

A study published in the JAMA Network revealed that Ozempic could be manufactured for 89 cents to $4.73 for a month’s supply, including a profit margin for Novo Nordisk. This finding undermines the company’s justification for the high U.S. prices, as the actual production costs are significantly lower.

Legislative and Public Scrutiny

Novo Nordisk’s rising profitability has not gone unnoticed. In 2023, the company’s net profits increased by 51% to DKK 83,683 million ($12 billion) and rose a further 28% in the first quarter of 2024 compared with the same period last year. This financial success, coupled with the high prices of their drugs in the U.S., has drawn significant attention from lawmakers.

Future Outlook

Novo Nordisk, like other drugmakers, aims to capitalize on its period of drug exclusivity before competitors can introduce their own versions of the appetite suppressant. However, with unsympathetic lawmakers scrutinizing their pricing strategies, CEO Jørgensen will need to present a compelling defense in September to justify the current pricing and maintain the company’s market position.

Oprah Weight Loss Muddled message

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Reflecting on Oprah’s Journey and the New Weight-Loss Drugs

I’ve been an Oprah fan since her eponymous show debuted on national television in 1986. Like many viewers, I saw her as a friend. As someone who has spent much of my life struggling with self-acceptance due to being overweight, I especially resonated with her very public battles to overcome the genetics that make people like us softer and fleshier, rather than the more socially accepted buff and sleek.

Now, thanks to a new class of drugs that includes Ozempic, Wegovy, and Mounjaro, Oprah’s struggles with weight seem to be behind her. She’s not the only public figure whose figure has shrunk recently, but she’s one of the few who has admitted to using medication to slim down, though she hasn’t named the specific drug. And, being Oprah, she’s leveraging her platform to shape the latest public discourse about weight, diet culture, and body shaming.

Earlier this year, she stepped down from the board of WeightWatchers. In March, she hosted “An Oprah Special: Shame, Blame and the Weight Loss Revolution” on ABC. In May, she did a three-hour livestream on YouTube, “Making the Shift: A New Way to Think About Weight.” These shows and specials featured experts, including physicians and psychologists, and shared numerous stories about the challenges of being overweight in our fatphobic society.

I’m profoundly glad we’re having these conversations, and I don’t have a problem with people taking weight-loss drugs to live healthier lives. But I’m struggling with Oprah’s message nonetheless. While acknowledging her well-established past role in judgmental diet culture, Oprah now claims to have moved past that chapter in her life. The semaglutide implication is that medical weight loss is somehow better—more elevated or pure—than past strategies. Maybe this is not her intention, but her words draw an arbitrary line between different weight-loss strategies while ignoring the societal pressures that push so many people to try them. That’s not the end of diet culture; it’s merely an evolution.

Oprah opened her May YouTube special with an impassioned monologue in which she told the audience repeatedly and convincingly that she’s done with body shaming and wants them to be done with it, too. But her campaign for body acceptance coincides with her new, more socially acceptable body—one she achieved with the help of drugs that the Food and Drug Administration has approved to treat people with diabetes and the medical management of obesity.

Consequences of the Surge in Semaglutides

A significant consequence of the surge in semaglutides is that these drugs, while never approved for cosmetic purposes in the U.S., are being used off-label for weight loss. This off-label use has led to shortages for people who need the medications for their intended use.

Promoting drugs to make people thin, regardless of their metabolic profile, pathologizes obesity and reinforces the inaccurate belief that a fat body is always an unhealthy one that needs fixing. And that, Oprah, is one of the foundational pillars of diet culture.

When I broke down a few years ago and cried to my general physician, Dr. B., about how my parents sent me to WeightWatchers when I was 11—setting me on a course of disordered eating that was still plaguing me nearly half a century later—she sent me to a nutritionist who helped me develop a healthier attitude about food and my body. The self-loathing still crops up from time to time, but I’m getting better at quelling it. The reminders from Dr. B. help. “If you’re not ill, obesity isn’t an illness,” she told me.

I prefer not to think of myself as obese, though the National Institutes of Health says otherwise. But I am definitely not ill. I’m 63, and my cholesterol, blood sugar, and blood pressure are low to normal. My resting heart rate is lower than the average for a woman my age, my colon is clean, and my knees, hips, and back (all my original body parts) work fine. Maybe it’s tempting fate to admit this, but I’m not on medication because I don’t need any.

At some point, I’ll get sick and die—that’s how most of us go—but for now, I’m healthy. Healthier, I daresay, than the skinny dentist who told me last summer that I should get a new doctor after I mentioned Dr. B. didn’t think I needed to lose weight. I’ve never had high cholesterol. Meanwhile, the skinny dentist had gotten skinnier to avoid taking statins.

One reason I have a healthy metabolic profile is that I eat well and exercise regularly. But even eating well and exercising regularly do not guarantee good health. One of my closest friends weighed 60 pounds less than I, ate better, and exercised regularly, and she died at 62 from ovarian cancer. No amount of dieting protects against the mutated BRCA gene that, it turns out, runs in her family. I won a better ticket in the genetic lottery, unless you count the fact that along with my healthy genes, I inherited a slow metabolism and a sweet tooth.

The Importance of a Holistic Perspective on Health

I wish Oprah had opened her YouTube show with a monologue about how losing weight helped her get healthier, and that fat people can also be healthy. Instead, she buried that critical information in the last half hour of a three-hour program. That’s when she invited a Yale endocrinologist onstage to confirm that our most important health numbers can’t be read on a scale; they’re the ones that reflect markers such as blood sugar levels, blood pressure, and cholesterol.

I’m not so naïve as to dismiss the reality that extra weight can be tough on your joints. In fact, it was a comment about joint health from my family doctor nearly 25 years ago that got me to lose 40 pounds on WeightWatchers (which I’ve since regained). I’m also aware that plenty of overweight people are at high risk of developing metabolic disorders.

Weight loss and body image will always be intertwined topics fraught with complexity. But when discussing weight loss and the drugs that make it easier to drop pounds, we need to emphasize the physiological benefits, not just the psychological ones. Continuing to focus on the connection between weight and self-image over the connection between weight and health doesn’t combat body shaming. Quite the opposite: It promotes and exacerbates it. That’s damaging for everybody, especially those of us who are overweight, healthy, and secure in the knowledge that our value comes from the good we do, not the way we look.