A new trial finds that GLP-1 agonists may help reduce knee osteoarthritis-related pain.
The
use of GLP-1 medications such as semaglutide — more widely known under the
brand names of Ozempic and Wegovy — have greatly increased over the last few
years.
There
has also been an increase in research examining other benefits these types of
drugs might offer aside from type 2 diabetes management and weight loss.
Recent
results from a phase 3 clinical trial show that semaglutide may help reduce
knee osteoarthritis-related pain in people with obesity.
The
use of glucagon-like peptide-1 (GLP-1) medications such as Wegovy and Ozempic
has greatly increased over the last few years.
While
these drugs are mainly used to help control type 2 diabetes and boost weight
loss, over the last few years, there has been a lot of research surrounding
GLP-1 medications, such as semaglutideTrusted Source, and how they provide
additional benefits.
For
example, recent studies report that GLP-1 drugs may have neuroprotective
benefitsTrusted Source, lower Alzheimer’s diseaseTrusted Source risk, and offer
protection against cardiovascular disease.
Now,
new clinical trial results recently published in The New England Journal of
Medicine show that semaglutide may also help reduce knee osteoarthritis-related
pain in people with obesity.
Semaglutide
reduces pain scores for knee osteoarthritis
This
new study featured the results from the STEP 9 phase 3 clinical trial conducted
by healthcare company Novo Nordisk aimed at evaluating the efficacy of
semaglutide versus placebo as an additional to lifestyle modifications — such
as eating a reduced-calorie diet
and
exercising — in lowering weight and knee osteoarthritis-related pain in
patients with obesity.
Researchers
recruited 407 participants with an average age of 56 and body-mass index (BMI)
of 40.3 for the study, who received either a 2.4 mg dose of semaglutide once a
week or a placebo for 68 weeks.
At
68 weeks, researchers found that participants taking semaglutide experienced a
mean decline in their body weight by 13.7%, compared to a 3.2% decrease in
those taking the placebo.
Researchers
also evaluated study participants’ Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) pain scores during this study. WOMAC is a
patient-reported questionnaire that helps rank pain on a scale of zero to 100,
with higher numbers indicating more pain.
Scientists
discovered that those taking semaglutide experienced a mean decrease in their
WOMAC pain score of 41.7 points from 70.9 at the start of the study, compared
to those taking the placebo whose WOMAC scores only decreased by 27.5 points.
“Obesity-related
knee osteoarthritis is a progressive condition that can lead to pain and
stiffness of the knee and impair critical daily functions such as walking or
moving around,” Henning Bliddal, MD, MSci, clinical professor in the Department
of Clinical Medicine and director of the Parker Institute at Copenhagen
University Hospital in Denmark and lead author of this study says in a press
release.
“The
risk of developing the condition is more than four times higher in people with
obesity. Weight reduction along with physical activity is often a recommended
approach to managing painful symptoms, but adherence can be challenging. There
is a significant need for non-surgical and sustainable treatment options for
those living with obesity-related osteoarthritis. The STEP 9 trial aimed to
provide rigorous evidence as to how semaglutide may help these people,” Bliddal
says.
Too
early to prescribe Ozempic for osteoarthritis
After
reviewing this study, Mir Ali, MD, a board certified general surgeon, bariatric
surgeon and medical director of MemorialCare Surgical Weight Loss Center at
Orange Coast Medical Center in Fountain Valley, CA, told Medical News Today
that its findings were in line with what doctors have seen with any kind of
weight loss.
“As
a patient loses weight, all of their medical conditions improve, including pain
from osteoarthritis. They’re taking pressure off of those joints, so it
improves their discomfort and we see that with our surgical weight loss
patients as well.” — Mir Ali, MD
“That’s
a big factor for a lot of people because the more discomfort they have in their
joints, the less active they are. And the less active they are, the easier it
is to gain weight. So if you can find ways to reduce pain and inflammation in
the joints to allow them to be more active,
then
they can be more proactive about exercise and other ways to improve their
health and lose weight,” Ali explained.
Ali
said he would be interested in seeing if researchers can eventually show that
semaglutide improves inflammation independent of weight loss.
“That
would be a tough study to design, but that would be helpful to show that
there’s some additional effect, not just the weight loss,” he added.
Semaglutide
may have anti-inflammatory effects
MNT
also spoke with Bert Mandelbaum, MD, sports medicine specialist and orthopedic
surgeon at Cedars-Sinai Kerlan-Jobe Institute and Co-Director of the
Regenerative Orthobiologic Center at Cedars-Sinai Medical Center in Los
Angeles, about this study.
“Certainly
we have always known that obesity is a risk factor for not only the onset of
osteoarthritis, but the progression of it — there is no question about that.
When you have a study like this that shows that there’s two things that are
happening at one time. One is that obviously their patients are losing weight,
so there’s a physical and mechanical aspect, but also there’s something about
semaglutide that also has an anti-inflammatory (effect).” — Bert Mandelbaum, MD
“It’s
not proven in this study, but there have been other studies that show that
(semaglutide) reduces cardiovascular risks. And the mechanisms of that are that
it is functionally an anti-inflammatory as well. It has another effect,
creating a decreased inflammation that affects blood vessels in and of
themselves, as well as other catabolic mediators such as the
interleukinsTrusted Source and TNF (tumor necrosis factor), and other
metalloproteases seem to be inhibited as part of its inhibitory inflammatory
effect,” Mandelbaum said.
Mandelbaum
said doctors are looking for help in reducing pain from osteoarthritis, whether
it’s related to obesity or not.
“Obesity
is just a negative factor that worsens the challenge for us. We’re trying to
reduce the amount of what we call catabolism and create an anabolic environment
for the joints,” he explained.
“I
think if researchers have found that we could reduce cardiovascular disease
with these medicines, we can reduce the pain from osteoarthritis,” Mandelbaum
continued.
“At
the end of the day, the orthobiologic family, we have to look at other things
that can make a difference, along with taking Wegovy or any of the other
GLP-1s. So I think it’s an interesting study, but (it) really portends us to
really think about what our next steps are so we can get into more adjuvant
approaches, in addition to this, at the same time,” he added.
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