‘It’s going to be ubiquitous’: Weight loss drugs may aid rheumatic disease treatment
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SAN DIEGO — GLP-1 agonists and other drugs that have recently made headlines for their weight loss applications will be useful in helping patients meet goals in psoriatic arthritis and other rheumatic diseases, according to a speaker here.
“We’re on the cusp of beginning to prescribe some of these ourselves,” Philip J. Mease, MD, director of rheumatology research at Swedish Medical Center and Providence-St. Joseph Health, in Seattle, told attendees at the 2024 Congress of Clinical Rheumatology West. “This is a prime attraction coming to us.
“We’re going to need to know how to pronounce these medicines, how to talk about their potential efficacy, how to talk to patients about their potential adverse effects and then go through the process of prior authorization,” he added.
Among patients with psoriasis, obesity is a “biomarker and risk factor, if you will, for the ultimate development of psoriatic arthritis,” Mease said. Meanwhile, for those with PsA, obesity also reduces the likelihood of meeting and maintaining treatment response.
In addition to mitigating obesity, GLP-1 agonists may also improve response through immunomodulatory effects of their own, Mease said. Both human and animal studies have shown GLP-1 agonists leading to “a reduction of various pro-inflammatory cytokines and acute phase reactants,” he added.
According to Mease, case reports have suggested that diabetes/weight loss drugs alone, without immunomodulatory therapy, could benefit patients with PsA.
Mease said he was recently referred a patient for evaluation of PsA who, after being placed on a weight loss drug, had lost 14 pounds. The patient said his arthritis symptoms had improved in the time since the weight loss, and when Mease examined him, he found normal ultrasound results and no swollen joints.
“So, the patient asked the question, ‘Could I just continue on this regimen and hold off on starting one of your immunomodulatory medicines?’” Mease said. “I went, ‘OK.’ I didn’t see that there was necessarily going to be harm.”
Mease also shared a case report from Alexis Elias Malavazos, MD, PhD, and colleagues involving a patient with obesity and type 2 diabetes whose psoriasis had been unsuccessfully treated with guselkumab (Tremfya, Janssen). In that patient, the GLP-1 agonist semaglutide (Wegovy, Novo Nordisk) led to a nearly 26% lower BMI over 10 months, as well as “fairly significant improvement” in multiple skin and joint scores, he said.
However, Mease cautioned that what he called “n of 1” experiments should be viewed with “a big grain of salt.” That said, he later expressed optimism that the weight loss drugs could bring benefits across the spectrum of rheumatic diseases.
“I think as we explore this topic in all of our rheumatic diseases and various musculoskeletal diseases and beyond, we’re going to find such evidence that there’s benefit to weight loss,” he said. “I think this is going to be ubiquitous.”
According to Mease, avenues for further research should feature combination therapy with immunomodulatory drugs vs. immunomodulatory drugs alone.
“We have seen that these new drugs are effective in achieving weight loss and have the sort of tantalizing potential for improving the pro-inflammatory cytokine milieu,” he said. “I think it’s prime time to consider doing studies where we combine one of these medications with one of our immunomodulatory medicines and compare to use of our immunomodulatory medicine alone in patients who are obese.”
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Mease PJ. Psoriatic Arthritis: Hot Topics and Treatment Update. Presented at The Congress of Clinical Rheumatology West; Sept. 26-29, 2024. (hybrid meeting).
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