DRUGS hailed a “miracle” in the fight against obesity and diabetes may have several new “superpowers”, scientists say.
As well as helping people lose weight and keep blood sugar levels under control, glucagon-like peptide-1 receptor agonists (GLP-1 RA) could also improve the health of millions in other ways, research shows.
They appear to have potential to treat Alzheimer’s and Parkinson’s, as well as heart disease, fatty liver disease, and chronic kidney disease.
Patients with sleep apnoea, heart failure and alcohol addiction could also benefit.
Daniel Drucker, a professor in the department of medicine at the University of Toronto, Canada, who studies the “superpower” meds, said: “One of the really interesting things about the GLP-1 drugs is that beyond the control of blood sugar and body weight, they also seem to reduce the complications of chronic metabolic disease.
“We know from clinical studies that GLP-1 does all this amazing stuff in people, but we don’t fully know how it works.”
Speaking to The Guardian, Dr Harshal Deshmukh, a consultant endocrinologist and senior clinical lecturer at the University of Hull, added: “Excessive weight has been identified as a significant risk factor for a range of comorbidities, including fatty liver, various cancers, dementia, and cardiovascular diseases.
“Given these associations, it’s not surprising that numerous clinical trials are currently investigating the potential impact of semaglutide on these health conditions.”
GLP-1 RAs like semaglutide and tirzepatide, sold under brand names such as Ozempic, Mounjaro and Zepbound, were first used to treat type 2 diabetes.
They were found to effectively manage blood glucose levels by increasing levels of incretins – a hormone which helps the body produce more insulin when needed and reduce the amount of glucose produced by the liver.
But researchers soon found they suppress users’ appetites – mimicking a hormone called glucagon-like peptide-1, which is usually released after eating.
As the medication makes people feel full, they tend to eat less and lose weight (around 10 per cent of their body weight).
Now, scientists have discovered several other potential wide-reaching uses.
Fatty liver disease
Zepbound shows promise as a treatment for fatty liver disease, according to its manufacturer Eli Lilly.
Mid-stage trials found almost three quarters of patients with the condition eradicated it after 52 weeks of taking the drug, compared to just 13 per cent of people taking a placebo.
Up to 70 per cent of people with type 2 diabetes and between 50 and 90 per cent of people suffering from obesity have non-alcoholic fatty liver disease (NAFLD), when excess fat builds up in the liver.
These patients are usually urged to lose weight, so taking drugs like Ozempic could also reduce the severity of liver disease.
Up to one in three people in the UK has early-stage NAFLD, where there are small amounts of fat in the liver, according to the NHS.
This doesn’t usually cause any immediate harm, but it can lead to serious liver damage, including cirrhosis, if it worsens.
The same medication is being tested on patients with heart failure and obesity.
Around 700 people have been enrolled to take part in the study, which is expected to be completed by July 2024.
But previous research, published in the New England Journal of Medicine, has found semaglutide, which works in a similar way, can reduce a patient with heart failure’s risk of a heart attack and stroke by 20 per cent.
“This is a pretty big deal,” lead author Dr Michael Lincoff said.
Another study, in the American Heart Association journal Hypertension, discovered that overweight or obese people who received weekly tirzepatide injections for nine months significantly lowered their blood pressure – a strong predictor of heart disease.
‘Weight loss’ drugs suppress appetite, so as well as eating less, some people taking them report wanting to drink less too, according to NPR.
Scientists don’t fully understand why, but it could be because the drugs target areas of the brain that regulate appetite as well as compulsive behaviours.
One study followed six people with alcohol use disorder (AUD), who were taking semaglutide for weight loss.
All six participants drank significantly less booze after taking the medication for between one and nine months.
A separate study of 153 obese adults found those who took semaglutide or tirzepatide reported drinking significantly less than those not on the medications.
The University of Copenhagen’s Psychiatric Centre Rigshospitalet is now exploring this idea, and the implications it could have on alcohol addiction, further.
Scientists are studying whether diabetes drugs that also promote weight loss can tackle some of the most difficult-to-treat brain disorders, including Alzheimer’s.
These medicines seem to address several aspects of the metabolic system impacted by the condition, including a protein called amyloid and inflammation.
The hope is that improving glucose utilisation and reducing inflammation in the entire body – including the brain – could slow the progression of Alzheimer’s.
Dr Ivan Koychev, senior clinical researcher at the University of Oxford, is specifically testing whether semaglutide can halt the earliest changes in the brains of people at risk of developing the condition.
He said: “We now know that people living with Alzheimer’s disease have high levels of inflammation in their brains.
“This inflammation likely speeds up the progression of their dementia.
“Semaglutide is a drug that reduces inflammation and is effective in patients with type 2 diabetes.
“This study explores whether the drug could also be used to treat Alzheimer’s disease, potentially by reducing brain inflammation.”
Several studies have shown an association between people being treated with certain GLP-1 RAs for their diabetes and a reduced risk of developing Parkinson’s.
According to the charity Cure Parkinson’s, people with diabetes are around 40 per cent more likely to develop Parkinson’s than those without it.
Sufferers who are diabetic also tend to see their symptoms develop more rapidly.
Early trial results suggest the diabetes drug lixisenatide, branded as Adlyxin, could slow the progression of Parkinson’s.
Researchers at University Hospital Toulouse in France found patients given lixisenatide for one year showed less motor disability compared to those taking a placebo.
Simon Stott, director of research at Cure Parkinson’s, a co-funder of the trial, said: “The initial results are very encouraging and provide further evidence that this class of diabetes drugs is doing something interesting in Parkinson’s.”
So-called ‘fat jabs’ could one day help treat sleep apnoea, it is hoped.
The condition happens when your breathing stops and starts while you are asleep.
Around 10million Brits are thought to have it, according to the Sleep Apnoea Trust.
It is more common in those who are overweight or obese. Research has shown weight loss can help treat symptoms.
There is so far little data on whether certain drugs could have the same effect, but tirzepatide is currently being tested.
Eli Lilly said it hopes to complete its trial, involving around 450 participants, by spring 2024.
How GLP-1 receptor agonist drugs work
GLP-1 receptor agonists are medicines used to treat type 2 diabetes and obesity.
They mimic the action of a hormone called GLP-1, which the stomach naturally releases when you eat food.
They help your body to make more insulin, reduce the amount of sugar your liver makes, slow the digestion of food, and reduce your appetite.
There are currently six GLP-1 receptor agonists available in the UK: exenatide, liraglutide, lixisenatide, dulaglutide, semaglutide, and tirzepatide.
Source: NHS and National Institute for Health and Care Excellence
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) – one of the most common causes of infertility – impacts around one in 10 women in the UK.
Many sufferers are overweight and found to have raised levels of testosterone, which is usually thought of as a ‘male hormone’.
Some researchers reckon weight loss drugs could help regulate hormones in people with PCOS, and therefore reduce symptoms and complications.
A study involving 27 obese patients diagnosed with PCOS found that after six months of treatment with semaglutide, they lost an average of 25lbs (11.5kg) and had more regular periods, suggesting their PCOS was under better control.
Another, carried out by the Women’s Hospital in Los Angeles, found that liraglutide – the active ingredient in Victoza and Saxenda – significantly reduced testosterone levels.
Allison Tuckman, who was not involved in the research, has been prescribed Ozempic off-label to treat her PCOS for three years.
She told NBC News it has helped address complications such as excess insulin production, high blood pressure and high cholesterol.
Novo Nordisk tested semaglutide on patients with type 2 diabetes and chronic kidney disease, but the trial was halted after early analysis revealed the drug was effective.
Full results have not yet been released, but the manufacturer is now funding another study to examine the drug’s impact on the kidneys.
A separate trial by Eli Lilly is investigating how tirzepatide might be able to treat obese patients with chronic kidney disease.
Dr Howard Forman, a professor at the Yale School of Medicine, told the New York Times: “We are on the very, very early upsweep of this whole industry, and nothing will surprise me.”