Q&A: Gastroparesis from Ozempic, Wegovy 'uncommon'

Key takeaways:

• Drugs like Ozempic and Wegovy are effective in reducing weight among patients with overweight or obesity.
• An expert said the risk for adverse events like severe gastroparesis are rare.

Recent reports in the media and legal action have raised questions about the safety of popular weight-loss drugs, particularly about whether they increase the risk for events such as gastroparesis and gastroenteritis.

Healio spoke with Lydia Alexander, MD, president-elect of the Obesity Medicine Association and chief medical officer of Enara Health, to learn more about the safety and efficacy of weight-loss drugs like Ozempic and Wegovy (semaglutide, Novo Nordisk) and what primary care physicians need to know about them.

Healio: How effective are ‘blockbuster drugs’ like Ozempic and Wegovy?

Alexander: At the moment, GLP-1 receptor agonist medications are the most effective anti-obesity medications on the market, producing 14.9% vs. 2.4% weight loss against placebo at 68 weeks (1 year at the 2.4 mg dose of semaglutide). Another medication, Mounjaro (tirzepatide, Eli Lilly), which is a two-hormone analog medication currently FDA approved to treat type 2 diabetes and will soon be approved for chronic weight management, is even more effective. Additionally, there are at least half a dozen anti-obesity medications in phase 2 and 3 trials equally or more effective.

Healio: How have they changed the landscape of obesity treatment?

Alexander: The landscape of obesity treatment has changed because this class of medications, hormone analogs to GLP-1 found in the gut, are highly effective anti-obesity medications, producing greater than 5% weight loss in 83.5% of patients and more than 15% in nearly half of those taking them. As a result, many chronic conditions like type 2 diabetes, high blood pressure, cholesterol and even sleep apnea can improve. Most importantly, the SELECT trial announcement that Wegovy reduced major adverse cardiovascular events (MACE) by 20% in a large trial is groundbreaking. It shows that weight loss and maintenance improves heart health. This means Wegovy can decrease heart attack and stroke risk in people, even if they do not have diabetes.

Healio: There have been some reports in mainstream media about a potential risk for severe gastroparesis. What does current evidence suggest about this risk? How common is it?

Alexander: Gastroparesis is a condition where delayed gastric emptying happens but there is no mechanical (physical) obstruction. It can cause nausea, vomiting, early satiety, bloating and/or upper abdominal pain. The current evidence suggests the risk for gastroparesis is extremely low.

Healio: What are the underlying mechanisms at play that could be causing or exacerbating severe gastroparesis in patients taking these medications?

Alexander: Gastroparesis can happen from diabetes mellitus, Parkinson’s disease, following surgery or with some medications. Many times, the cause is unknown (called idiopathic). In diabetes, gastroparesis often develops as a result of damage to the nerves that control the muscles of the stomach.

Healio: Should patients stop taking these medications if they develop symptoms of gastroparesis?

Alexander: If gastroparesis is suspected, it is important to immediately see your medical provider for further evaluation and to determine next best steps. This highlights the importance of medical supervision when taking prescription medication because, although gastroparesis is a rare complication with GLP-1s, it can be very serious.

Healio: What other risks are associated with these medications?

Alexander: Some of the more severe risks associated with GLP-1s are medullary thyroid carcinoma in patients with a personal or family history of it or another rare condition called multiple endocrine neoplasia, and these medications should not be taken. Other serious risks include pancreatitis, acute gall bladder disease, diabetic retinopathy and suicidal ideation.

Healio: Do the risks outweigh the benefits?

Alexander: The benefits of Wegovy and Ozempic are substantial. Although adverse reactions can occur and may be severe, they are uncommon so that the overall benefits of MACE reduction and improvement seen to happen with many chronic conditions with Wegovy are substantial.

Healio: What is the take-home message for PCPs?

Alexander: Obesity is a malfunction of the body’s weight-regulating mechanisms, which makes weight gain easier for some than others and can cause a lot of health conditions. Treating obesity as a disease to improve long-term health outcomes is vital to the care of our patients. Highly effective anti-obesity medications can improve overall health. Recent studies show they can even decrease the risk for heart attack and strokes, increase lifespan and quality of life and should be part of our armamentarium to treat obesity. With nearly 7,000 physicians board-certified in obesity medicine, the expertise to treat the roots rather than the fruits of many chronic diseases is available. PCPs can treat and refer the treatment of obesity.

Healio: Do you have anything else to add?

Alexander: I would like to add the importance of treating obesity as a chronic disease just as we do high blood pressure and depression rather than a personal failing of our willpower.

Reference:

• They took blockbuster drugs for weight loss and diabetes. Now their stomachs are paralyzed. https://www.cnn.com/2023/07/25/health/weight-loss-diabetes-drugs-gastroparesis/index.html. Published July 25, 2023. Accessed Aug. 21, 2023.