Weight Loss Drugs Like Ozempic Tied to Increased Risk of Severe Stomach Problems
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People with obesity who take popular injected drugs like Ozempic and Wegovy to lose weight may have a higher risk of severe stomach problems than they would have with some other weight loss medications, a new study suggests.
For the study, researchers examined health insurance claims data for about 5,400 people with obesity, but not diabetes, who were prescribed medicines containing semaglutide, the active ingredient in Ozempic and Wegovy; liraglutide, the active ingredient in Saxenda; or Contrave, an older weight loss pill containing a combination of the ingredients bupropion and naltrexone.
Compared with people who took the older pill, individuals who took Ozempic (a type 2 diabetes drug that can be prescribed off label for weight loss) or the obesity drugs Wegovy and Saxenda were more than 9 times as likely to develop pancreatitis, according to study results published in JAMA. Pancreatitis refers to inflammation in the pancreas that can cause severe abdominal pain and often requires surgery. The new injected weight loss medicines were also associated with a more than quadrupled risk of bowel obstruction, and a more than tripled risk of gastroparesis, or stomach paralysis, which can stop food from moving through the intestines.
“Given the wide use of these drugs, these adverse events, although rare, must be considered by patients thinking about using them for weight loss,” lead study author Mohit Sodhi, a medical student at the University of British Columbia in Vancouver, Canada, said in a statement. “The risk calculus will differ depending on whether a patient is using these drugs for diabetes, obesity, or just general weight loss. People who are otherwise healthy may be less willing to accept these potentially serious adverse events.”
Use of Drugs Like Ozempic and Wegovy Expanding Rapidly for Weight Loss
Ozempic, Wegovy, and Saxenda are all in a family of medicines known as GLP-1 drugs, which mimic natural hormones that regulate hunger and feelings of fullness. These medicines were prescribed to about 40 million people in the United States last year, according to the statement from the study authors.
Some previous research has pointed to the potential for GLP-1 drugs to cause a variety of common gastrointestinal side effects, such as nausea, vomiting, diarrhea, abdominal pain, and constipation. Some rare but more serious side effects, like stomach paralysis and intestinal paralysis, have also been reported before.
But the new study is the first to look at serious gastrointestinal side effects in people with obesity who don’t have type 2 diabetes, according to the report in JAMA. The popularity of the drugs skyrocketed on social media — and shortages ensued — as rumors spread of celebrities without diabetes using them off label.
“There have been anecdotal reports of some patients using these drugs for weight loss and then presenting with repeated episodes of nausea and vomiting secondary to a condition referred to as gastroparesis,” Mahyar Etminan, PharmD, senior author of the new study and an associate professor at the University of British Columbia, said in the statement. “But until now, there hasn’t been any data from large epidemiologic studies.”
The new study examined health insurance claim records for about 16 million U.S. patients and looked at people prescribed either semaglutide or liraglutide, two main GLP-1 agonists, between 2006 and 2020. They included patients with a recent history of obesity, but no history of diabetes. The final analysis included 613 people prescribed semaglutide, 4,144 people prescribed liraglutide, and 654 people on the bupropion-naltrexone combination pill.
Severe Stomach Side Effects Still Rare With GLP-1 Drugs
Even though the risk of severe gastrointestinal events is much higher with the GLP-1 drugs, these cases are still very rare, the study authors note. For example, only about 1 percent of people on Ozempic experienced stomach paralysis.
The study wasn’t designed to prove whether or how GLP-1 drugs might directly cause gastrointestinal complications.
More research is also needed, particularly longer studies with larger groups of patients, in order to get a clearer picture of which patients might be most at risk for severe gastrointestinal side effects, says W. Timothy Garvey, MD, a professor and director of the diabetes research center at the University of Alabama at Birmingham, who wasn’t involved in the new study.
In the meantime, the study findings underscore the importance of getting these medicines from a doctor, and not from the internet, so that it’s possible to have a thorough discussion of the potential risks, Dr. Garvey says. Patients with active or recurrent gallbladder disease, with active or recurrent pancreatitis, and with a history of diabetic gastroparesis or paralytic ileus may not be able to safely take GLP-1 drugs due to the gastrointestinal risks, Garvey adds.
“The practice of dispensing these drugs online, including through diet and lifestyle companies such as Weight Watchers and Noom, without a comprehensive in-person assessment by a healthcare professional, is emerging as an unwanted and dangerous practice,” Garvey says. “This will result in the availability of these medications to patients at risk of harm, and will not identify other obesity-related complications warranting therapy.”
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