The largest and longest study of the obesity drug Wegovy showed that people maintained significant weight loss for at least four years, with fewer serious adverse events than those who received “dummy” placebo treatment.
Doctors say the discovery will increase pressure on UK health authorities, who currently limit treatment to just two years.
Results revealed at international event obesity The conference shows that those who received weekly injections of the drug lost weight during the first 65 weeks of treatment and then maintained a stable body weight over the long term.
On average, they lost 10.2% of their body weight and 7.7 cm from their waist after four years.
Significantly, even those who were only slightly obese, or who lost only a small amount of weight, still benefited from a reduction in cardiovascular risks, according to results presented at the European Congress on Obesity in Venice and published in the journal Nature Medicine.
Dr. Simon Cork, senior lecturer in physiology at Anglia Ruskin University, who was not involved in the study, said the results show for the first time that patients maintain a “weight plateau” if they continue long-term treatment.
“Importantly, one of the UK health service’s decisions to limit (treatment) to two years was due to questionable long-term cost-effectiveness,” he said.
He added: “The fact that these data demonstrate improvement in cardiovascular and metabolic parameters over four years may somewhat negate this argument.
“This study also clearly demonstrates that obesity is a lifelong condition and that NICE’s decision to limit prescribing to two years does a disservice to patients suffering from obesity.”
The SELECT (Semaglutide and Cardiovascular Outcomes) trial enrolled 17,604 obese or overweight adults from 41 countries. None of them had diabetes, but all had suffered a heart attack, stroke or peripheral artery disease.
During the first two years of the study, the proportion of people who were obese fell dramatically, from 71% to 43% in the group receiving Wegovy.
But in those who received placebo injections, the rate fell only slightly, from 72% to 68%.
After three years of treatment, participants had a 20% lower risk of heart attack, stroke or death from cardiovascular disease, according to an analysis released last year.
Professor Donna Ryan, from the Pennington Biomedical Research Center in New Orleans, USA, who led the study, said weight loss was observed regardless of age, sex and ethnicity.
“This degree of weight loss in such a large and diverse population suggests that it may be possible to impact the public health burden of multiple obesity-related diseases,” she said.
“Although our trial focused on cardiovascular events, many other chronic diseases, including various types of cancer, osteoarthritis, anxiety and depression, would benefit from effective weight management.”
The study showed that serious adverse events were less common in those who received the drug than in those who received a placebo.
This was mainly because people taking Wegovy were less likely to have heart problems.
But people taking the drug were more likely to get gallbladder stones and stop taking it due to gastrointestinal problems such as nausea and diarrhea.
A second analysis of the same group of patients, led by researchers in the United Kingdom, showed that cardiovascular benefits were seen even in patients who were only mildly obese or who lost only modest amounts of weight.
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Professor John Deanfield, from University College London, said the discovery had “important” clinical implications.
“About half of the patients I see in my cardiovascular practice have weight levels equivalent to those in the SELECT study and will likely benefit from taking Semaglutide in addition to their usual level of care.
“Our findings show that the magnitude of the effect of semaglutide treatment is independent of the amount of weight lost, suggesting that the drug has other actions that reduce cardiovascular risk in addition to reducing unhealthy body fat.
“These alternative mechanisms could include positive impacts on blood sugar, blood pressure or inflammation, as well as direct effects on heart muscle and blood vessels, or a combination of one or more of these.”
However, researchers warn that there is still no evidence that the treatment prevents serious cardiovascular events.
Semaglutide, the active ingredient in Wegovy, is part of a growing class of GLP-1 medications that make people feel full by reducing calorie intake.
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