Semaglutide shows potential as smoking cessation tool
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Key takeaways:
- Semaglutide use was linked to lower risks for smoking cessation prescriptions and counseling.
- Further investigation is needed to confirm any causal relationship.
Individuals with type 2 diabetes who received semaglutide had lower probability for medical care related to tobacco dependence compared with other antidiabetes medications, the results of a study in the Annals of Internal Medicine showed.
The findings suggest that semaglutide may have a role in helping smokers quit smoking that warrants further investigation and confirmation via clinical trials, according to researchers.
“Though there are effective medications for smoking cessation, not every smoker responds to them, and the relapse rates are high,” William Wang, from Case Western Reserve University School of Medicine, and colleagues wrote. “Thus, alternative medications for smoking cessation are needed.”
They pointed out that semaglutide (Wegovy/Ozempic, Novo Nordisk) — a glucagon-like peptide (GLP-1) receptor agonist — has recently been linked with reduced risk for incidence and relapse of cannabis use disorder, but that the drug’s impact on tobacco dependence-related medical care in real-world settings is limited.
In the emulation target trial, researchers compared semaglutide with several types of antidiabetes medications — including insulin, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, metformin, dipeptidyl-peptidase-4 inhibitors and other GLP-1 receptor agonists — among 222,942 new users with tobacco dependency and type 2 diabetes.
Wang and colleagues assessed the drugs’ effects on several measures of tobacco dependence-related medical care such as smoking cessation medical prescriptions and medical encounters with a diagnosis of tobacco dependence using Cox proportional hazards models and Kaplan-Meier survival analyses.
Overall, 5,967 of the new users received semaglutide.
Researchers reported a significant association between semaglutide use and a lower risk for medical encounters with a diagnosis of tobacco dependence compared with all seven antidiabetes medications.
They observed the strongest effect from semaglutide use when compared with insulins (HR = 0.68; 95% CI, 0.63-0.74), whereas the weakest — but still statistically significant — effect came during comparisons with other GLP-1 receptor agonists (HR = 0.88; 95% CI, 0.81-0.96).
Study investigators also noted an association between semaglutide and significantly lower risk for smoking cessation medication prescriptions, with it being strongest compared with insulins (HR = 0.32; 95% CI, 0.28-0.38) and weakest compared with other GLP-1 receptor agonists (HR = 0.62; 95% CI, 0.52-0.74).
Wang and colleagues further found less frequent need for smoking cessation counseling among those who received semaglutide compared with other antidiabetes medications, with HRs ranging from 0.69 to 0.85.
The researchers added that most of the differences in group comparisons occurred within 30 days of prescription initiation. Meanwhile “similar effects were observed in subpopulations without and with a diagnosis of obesity,” they added.
Wang and colleagues explained that reductions in tobacco dependence-related medical encounters “could potentially suggest a reduction in tobacco use or relapse.”
“However, a reduction in these measures could also reflect other scenarios, such as a reduced willingness to seek help to quit smoking,” they wrote.
They explained that the underlying mechanisms behind the findings are unclear, “but preclinical studies suggest that they likely reflect the involvement of GLP-1 receptors in modulating the brain’s reward and aversive systems.”
Researchers identified several study limitations, which include potential underdiagnosis, overdiagnosis and biases and the shorter follow-up period.
Ultimately, these limitations “preclude firm conclusions and should not be interpreted to justify clinicians’ use of semaglutide off-label for smoking cessation,” the researchers concluded. “This will need to be examined in randomized clinical trials.”