Once-Weekly Semaglutide in Adults with Overweight or Obesity

  • Wilding, John P.H. D.M.
  • Batterham, Rachel L. M.B., B.S., Ph.D.
  • Calanna, Salvatore Ph.D.
  • Davies, Melanie M.D.
  • Van Gaal, Luc F. M.D., Ph.D.
  • Lingvay, Ildiko M.D., M.P.H., M.S.C.S.
  • McGowan, Barbara M. M.D., Ph.D.
  • Rosenstock, Julio M.D.
  • Tran, Marie T.D. M.D., Ph.D.
  • Wadden, Thomas A. Ph.D.
  • Wharton, Sean M.D., Pharm.D.
  • Yokote, Koutaro M.D., Ph.D.
  • Zeuthen, Niels M.Sc.
  • Kushner, Robert F. M.D.
New England Journal of Medicine 384(11):p 989-1002, March 18, 2021. | DOI: 10.1056/NEJMoa2032183

Abstract

Background

Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once-weekly semaglutide at a dose of 2.4 mg as an adjunct to lifestyle intervention has not been confirmed.

Methods

In this double-blind trial, we enrolled 1961 adults with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or greater (≥27 in persons with ≥1 weight-related coexisting condition), who did not have diabetes, and randomly assigned them, in a 2:1 ratio, to 68 weeks of treatment with once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo, plus lifestyle intervention. The coprimary end points were the percentage change in body weight and weight reduction of at least 5%. The primary estimand (a precise description of the treatment effect reflecting the objective of the clinical trial) assessed effects regardless of treatment discontinuation or rescue interventions.

Results

The mean change in body weight from baseline to week 68 was -14.9% in the semaglutide group as compared with -2.4% with placebo, for an estimated treatment difference of -12.4 percentage points (95% confidence interval [CI], -13.4 to -11.5; P<0.001). More participants in the semaglutide group than in the placebo group achieved weight reductions of 5% or more (1047 participants [86.4%] vs. 182 [31.5%]), 10% or more (838 [69.1%] vs. 69 [12.0%]), and 15% or more (612 [50.5%] vs. 28 [4.9%]) at week 68 (P<0.001 for all three comparisons of odds). The change in body weight from baseline to week 68 was -15.3 kg in the semaglutide group as compared with -2.6 kg in the placebo group (estimated treatment difference, -12.7 kg; 95% CI, -13.7 to -11.7). Participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo. Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%]).

Conclusions

In participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight. (Funded by Novo Nordisk; STEP 1 ClinicalTrials.gov number, NCT03548935).

Weight and Health — Pathophysiology and Therapies

  • Aronne, Louis J. M.D.
  • Bramblette, Sarah
  • Huett-Garcia, Amber
  • Ingelfinger, Julie R. M.D.
  • Jastreboff, Ania M. M.D., Ph.D.
  • Machineni, Sriram M.D., Ph.D.
  • Massie, Nikki
  • Rosen, Clifford J. Ph.D.
New England Journal of Medicine 387(24):p e62, December 15, 2022. | DOI: 10.1056/NEJMp2214423

When Weight Impacts Health

  • Aronne, Louis J. M.D.
  • Bramblette, Sarah
  • Ingelfinger, Julie R. M.D.
  • Jastreboff, Ania M. M.D., Ph.D.
  • Machineni, Sriram M.D., Ph.D.
  • Massie, Nikki
  • Rosen, Clifford J. Ph.D.
New England Journal of Medicine 388(2):p e2, January 12, 2023. | DOI: 10.1056/NEJMp2215794

Once-Weekly Semaglutide in Adults with Overweight or Obesity

  • Javor, Eugen M.Pharm.
  • Lucijanić, Marko M.D., Ph.D.
  • Skelin, Marko Ph.D.
New England Journal of Medicine 385(1):p e4(1), July 1, 2021. | DOI: 10.1056/NEJMc2106918

STEP 1 for Effective Weight Control — Another First Step?

  • Ingelfinger, Julie R. M.D.
  • Rosen, Clifford J. M.D.
New England Journal of Medicine 384(11):p 1066-1067, March 18, 2021. | DOI: 10.1056/NEJMe2101705
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