Ozempic and other similar medications have proven effective in regulating blood sugar and losing weight. Now, scientists are exploring whether it could be just as ‘game-changing’ in treating a wide range of other conditions… from addiction and liver disease, to the common cause of infertility.
Sweeping invasion
“It’s like a snowball that turned into an avalanche,” says Lindsay Allen, a health economist at Northwestern Medicine. She adds that as these drugs gain momentum, “they leave behind this landscape that is completely reshaped.”
Much of the research on other uses of semaglutide, the compound found in Ozempic and Wegovy, and tirzepatide, the substance in Mounjaro and Zepbound, is only in the early stages.
There are a number of questions that scientists seek to answer: Are the benefits of these medications limited only to weight loss? Or does it have other effects, such as reducing inflammation in the body, or calming the brain’s compulsive thoughts, making it possible to treat more diseases? We probably won’t know anytime soon.
“We’re still learning how these drugs work,” says Dr. Daniel Drucker, one of the first researchers to study these drugs. Drucker works as a consultant for Novo Nordisk, which produces Ozempic and Wegovy.
People with the conditions listed below, many of whom have few good treatment options, could benefit in the long term if these trials are successful. For weight-loss drug makers, each new use could propel the drugs to greater success.
New therapeutic targets
Some of these applications — including treatments for heart disease and sleep apnea, which each affect tens of millions of people — have become targets for these companies, and can be particularly lucrative. These drugs are a “gold mine,” Allen said, as “there is no upper limit to where the market is going,” and as evidence emerges from these studies, researchers will get a clearer idea of exactly how these drugs work in the body. If they can cure more diseases, they could radically change medicine again.
Alcoholism
* the problem: Alcohol use disorder, also known as alcoholism, is common, with nearly 30 million people in the United States affected by the condition in 2022. But people are rarely diagnosed with this condition, and it is often very difficult for them to find treatment. . There are effective medications on the market, but some people who could benefit from them are not even aware of their existence.
*Therapeutic potential: Anecdotally, some people who take medications like Ozempic say the medications make them want to drink less and, in some cases, stop drinking alcohol altogether. Researchers are trying to understand why. Since people feel full when taking these drugs, they may lose interest in alcohol as well as food. It is also possible that because these drugs target parts of the brain that regulate appetite, they could also affect compulsive behaviors that may involve those areas of the brain, such as alcohol use, stimulants, gambling, smoking, or even nail biting.
*Early evidence: One small study followed six people with alcohol use disorder who were taking semaglutide to lose weight. All six drank significantly less after taking the drug for a period ranging between one and nine months. In an online survey of 153 obese adults, most of whom were white and women, those who took semaglutide or tirzepatide reported drinking significantly less than their peers who did not take the medications.
However, researchers recently urged doctors not to use medications to treat alcohol use disorder without conducting further research.
Polycystic ovary syndrome
* the problem: Up to 5 million women in the United States have polycystic ovary syndrome, or PCOS. This condition is the main cause of infertility, and causes irregular menstruation. There are treatments available — diet changes and exercise, birth control pills, and the diabetes medication metformin — but they don’t work for everyone.
*Capabilities: Researchers believe that high testosterone levels contribute to polycystic ovary syndrome. When women with this condition lose weight, their testosterone levels often decrease. Dr. Melanie Cree, who is leading one of the early studies to see if semaglutide can resolve PCOS symptoms, said medications like Ozempic can help regulate hormones in women with PCOS.
*Early evidence: A small study of 27 women with obesity and PCOS who took low-dose semaglutide found that after 6 months, most participants had lost weight, and their periods were more regular, suggesting that their PCOS was under better control. Cree completed a study of semaglutide in teenage girls with polycystic ovary syndrome that showed similar results, and she is currently recruiting for another study focused on menstrual regularity.
Liver diseases
*the problem: Up to 70 percent of people with type 2 diabetes and 50 percent to 90 percent of people with obesity have nonalcoholic fatty liver disease, NAFLD, which occurs when excess fat accumulates in the liver. This condition can cause severe liver damage to the point that some patients end up needing a liver transplant.
*Capabilities: Doctors usually urge obese or overweight patients with nonalcoholic fatty liver disease (NAFLD) to lose weight in order to reduce the amount of fat and inflammation in the liver. Because medications like Ozempic cause weight loss, they may also reduce the amount of fat stored in the liver. Type 2 diabetes also increases the risk of NAFLD through its treatment, so medications like Ozempic may also reduce the risk or severity of liver disease.
Scientists have two other theories about how the drugs can help: by improving insulin resistance common in people with NAFLD, and by reducing inflammation that can damage the liver.
*Early evidence: A Novo Nordisk-funded study found that compared with placebo, semaglutide did not significantly improve liver scarring or resolve non-alcoholic steatohepatitis, or NASH, a severe form of non-alcoholic fatty liver disease. The study included people with cirrhosis, or permanently damaged livers. A larger trial funded by Novo Nordisk found that early-stage patients who took semaglutide were more likely than those who took a placebo to see their NASH resolved, but not more likely to see significant improvement in their scars. Novo Nordisk is now conducting a larger clinical trial of semaglutide and non-alcoholic steatohepatitis (NASH), and the Food and Drug Administration has classified the drug as a “breakthrough therapy” for the disease, which would expedite regulatory review. Researchers with funding from Eli Lilly are also investigating whether tirzepatide can treat non-alcoholic steatohepatitis (NASH).
heart and blood vessels
* the problem: Heart disease will kill nearly 700,000 people in the United States in 2022, making it the leading cause of death in the country. Experts say there is an urgent need for new treatments that can reduce the risk of heart attacks and strokes, as well as improve symptoms such as fatigue and shortness of breath that can make it difficult for people with heart disease to get through the day.
*Capabilities: Obesity greatly increases the risk of cardiovascular disease, which is why some doctors believe that losing weight may treat and prevent heart problems. Medications may also be able to help by reducing inflammation, which can lead to plaque formation in the heart and encourage blood clots.
*Early evidence: Last November, a large trial showed that semaglutide reduced the risk of events such as heart attacks and strokes by 20 percent among obese and overweight people and those with heart disease.
Another trial in people with obesity and a certain type of heart failure found that semaglutide could improve symptoms and make exercise easier. Eli Lilly is conducting its own trial on the drug tirzepatide and heart failure. More studies are in the works: Researchers are studying whether semaglutide can reduce plaque in the heart, improve symptoms of heart failure, or reduce damage from strokes.
Sleep Apnea
* the problem: An estimated 30 million people in the United States suffer from obstructive sleep apnea, in which breathing repeatedly stops and starts during sleep. Treatments such as the use of continuous positive airway pressure (CPAP) machines can help, although patients often find them uncomfortable.
Many people with sleep apnea go undiagnosed. If not treated properly, the condition can significantly affect people’s health, and can increase the risk of complications such as heart disease and type 2 diabetes.
*Capabilities: Sleep apnea is more common among obese people, and is due to a complex set of factors, including that fat deposits in the neck can block the airway when a person is lying down. Research has shown that losing weight, including through obesity surgery, can help.
*Early evidence. There is very little data yet, although an Eli Lilly spokesman said the company expects to complete a study on terzepatide and sleep apnea in the spring of 2024. Novo Nordisk is not currently studying what If semaglutide can treat sleep apnea.
Kidney disease
* the problem: Nearly 1 in 3 adults with type 2 diabetes also have chronic kidney disease, which occurs when the kidneys are damaged and can’t function properly. Patients with this disease may eventually need dialysis or a kidney transplant, and if untreated, the condition can be fatal.
*Capabilities: Dr. George Bakris, who participated in the semaglutide trial in people with type 2 diabetes and chronic kidney disease, which was supported by Novo Nordisk, says that kidney damage occurs slowly over time, and in almost all cases it is irreversible. Medications like Ozempic may be able to prevent further damage, in part because losing weight reduces the risk of high blood pressure and type 2 diabetes, which are risk factors for chronic kidney disease.
It’s not entirely clear how these medications may improve chronic kidney disease, but one possible factor is that they may reduce inflammation, which can be harmfully high in people with this condition.
*Early evidence: Novo Nordisk announced last October that it had halted a trial of semaglutide in people with type 2 diabetes and chronic kidney disease after an early analysis showed that the drug was effective, although the company has not yet published the data. The company is funding another study to examine how semaglutide works in the kidneys.
Eli Lilly is funding a trial of the drug tirzepatide in people suffering from obesity and chronic kidney disease. These studies and others are part of what Dr. Howard Foreman, a professor at Yale University School of Medicine who specializes in health policy, calls “an explosion of opportunity.” It remains to be seen whether these opportunities can become new treatments.
* New York Times service
