Continued Hype for Semaglutide Rather than Weight Loss

Drug sales efforts and research efforts merge at the boundary. Big, flashy, confirming trials of hot new drugs with already proven effects are more readily funded for all of the obvious reasons, primarily that the expected good results will help to sell more drugs. The hot new drugs of the past few years are GLP-1 receptor agonists, the first well-backed pharmaceutical answer to the widespread prevalence of obesity and its harmful consequences to health and longevity. The beneficial effects of losing excess weight (and specifically excess visceral fat tissue) are broad and sizable. Those who sell GLP-1 receptor agonists such as semaglutide are the first to lay these benefits at the feet of their drugs instead of loss of weight. As an example, the publicity materials noted here make no mention of weight loss whatsoever.

The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) study is a double-blind, randomised, placebo-controlled international trial comprising 3,533 patients, with a median follow-up period of 3.4 years. The trial was designed to assess the efficacy and safety of semaglutide, a once-weekly subcutaneous glucagon-like peptide 1 (GLP-1) receptor agonist, in preventing major kidney outcomes, specifically kidney failure, substantial loss of kidney function, and death from kidney or cardiovascular causes, in individuals with type 2 diabetes and chronic kidney disease. Patients either received semaglutide 1.0 mg once weekly or placebo.

Participants who received semaglutide had a 24% risk reduction for the composite primary endpoint, including kidney outcomes and death due to cardiovascular and kidney causes, compared to those who received placebo. This reduction risk was consistent across both kidney-specific and cardiovascular death outcomes. Secondary endpoints also showed significant improvements with semaglutide. Specifically, the total estimated glomerular filtration rate (eGFR) slope was 1.16 ml/min/1.73m2/year slower, the risk of major cardiovascular events was decreased by 18%, and the risk of all-cause mortality was reduced by 20%. This evidence of efficacy, combined with fewer serious adverse events in the semaglutide group, offers hope to millions of patients globally who face the daunting prospect of chronic kidney disease and type 2 diabetes, and their related complications.


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