Weight loss with semaglutide reduces pain, improves function in knee osteoarthritis
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Key takeaways:
- Patients with knee OA treated with semaglutide had significant weight loss and knee OA pain reduction vs. placebo.
- Physical function also improved favorably compared with the placebo group.
Weight loss from weekly semaglutide injections accompanied significant reductions in pain related to knee osteoarthritis, according to data published in The New England Journal of Medicine.
“Treatment guidelines recommend weight reduction and physical activity as first-line management for obesity-related knee osteoarthritis,” Henning Bliddal, MD, of the Parker Institute at Copenhagen University Hospital, and colleagues wrote. “Clinically important weight reduction requires a combination of a reduced-calorie diet and patient-centered physical-activity interventions, which may be challenging to adhere to but have been shown to improve patient-reported outcomes related to pain. Bariatric surgery may reduce knee pain in persons with obesity, although data from randomized, controlled trials are lacking.
“There remains an unmet need for weight-management medications that can facilitate nonsurgical, sustained weight reduction and reduce pain in persons with obesity-related knee osteoarthritis,” they added. “The effect of glucagon-like peptide-1 (GLP-1) receptor agonists in persons with obesity and knee osteoarthritis in this population has not been well-established.”
To test the impact of a GLP-1 receptor weight loss medication on knee OA outcomes, Bliddal and colleagues conducted a double-blind, randomized, placebo-controlled trial at 61 sites across 11 countries. The researchers administered 2.4 mg subcutaneous semaglutide (Wegovy, Novo Nordisk) once weekly to patients with obesity and moderate knee OA, who had at least moderate pain, and compared their outcomes with a placebo group over 68 weeks.
The study included 407 adults (mean age, 56 years; 81.6% women; mean BMI, 40.3) randomly assigned in a 2:1 ratio — 271 to semaglutide, 136 to placebo. The key endpoints were the percentage change in weight from baseline to week 68; change in pain levels, as measured with the 100-point scale Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); and change in physical function, evaluated via the 36-item Short Form Health Survey (SF-36).
From baseline to week 68, the semaglutide group demonstrated an average –13.7% change in body weight vs. –3.2% in the placebo group, according to the researchers. Patients treated with semaglutide also experienced more WOMAC pain reduction (–41.7 points vs. –27.5 points) and greater SF-36 physical function improvement (12 points vs. 6.5 points) on average, compared with the placebo group.
Serious adverse events were similar in incidence between the groups. Adverse events, most commonly gastrointestinal disorders, led to discontinuation for 6.7% in the semaglutide group and 3% in the placebo group, according to the researchers.
“This randomized, double-blind, placebo-controlled trial showed that treatment with semaglutide alleviated pain related to osteoarthritis of the knee among persons with obesity and knee osteoarthritis,” Bliddal and colleagues wrote. “The findings support the use of once-weekly subcutaneous semaglutide at a dose of 2.4 mg for weight management and treatment of pain in persons with obesity and moderate to severe pain due to knee osteoarthritis.”
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