From the Guidelines
Wegovy (semaglutide) is contraindicated in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2).
Key Points
- The contraindication is based on animal studies, as noted in the 2022 guideline on pharmacological interventions for adults with obesity 1.
- This contraindication is consistently mentioned across various studies and guidelines, including the 2023 consensus on care and management of obesity in South and Southeast Asia 1, the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes 1, and the 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1.
- The black box warning for semaglutide also mentions the risk of thyroid C-cell tumors in rodents, with unknown human relevance, as stated in the 2023 standards of care in diabetes 1.
- It is essential to consider this contraindication when prescribing Wegovy (semaglutide) to patients, especially those with a history of thyroid cancer or MEN2.
Important Considerations
- Patients with a personal or family history of medullary thyroid cancer or MEN2 should not be prescribed Wegovy (semaglutide) due to the potential risk of thyroid C-cell tumors.
- Healthcare providers should carefully evaluate the medical history of patients before initiating treatment with Wegovy (semaglutide).
- The benefits and risks of using Wegovy (semaglutide) should be weighed carefully, considering the individual patient's medical history and risk factors.
From the FDA Drug Label
WARNING: RISK OF THYROID C-CELL TUMORS See full prescribing information for complete boxed warning. • In rodents, semaglutide causes thyroid C-cell tumors. It is unknown whether OZEMPIC causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined (5.1,13.1). • OZEMPIC is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
4 CONTRAINDICATIONS
OZEMPIC is contraindicated in patients with: • A personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) [see Warnings and Precautions (5.1)].
The contraindications of Wegovy (semaglutide) in patients with thyroid cancer are:
- A personal or family history of medullary thyroid carcinoma (MTC)
- Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 2 2
From the Research
Contraindications of Wegovy (Semaglutide) in Patients with Thyroid Cancer
- The use of glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide, has been linked to an increased risk of thyroid cancer 3, 4.
- A boxed warning exists for GLP-1 receptor agonists for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 5.
- Studies have shown that GLP-1 analogues, including semaglutide, may increase the risk of thyroid C-cell pathology in rodents, but the risk in humans is still uncertain 3, 6.
- A systematic review and meta-analysis found that semaglutide use was not associated with an increased risk of thyroid cancer, but the evidence was not conclusive due to the low incidence of this condition 6.
- Another study found that semaglutide induces mostly mild-to-moderate and transient gastrointestinal disturbances, and increases the risk of biliary disease, but no unexpected safety issues have arisen to date, including thyroid cancer 7.
Key Findings
- GLP-1 receptor agonists, including semaglutide, may increase the risk of thyroid cancer, particularly medullary thyroid cancer 4.
- The risk of thyroid cancer associated with semaglutide is still uncertain and requires further study 6, 7.
- Patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 should be cautious when using semaglutide due to the potential increased risk of thyroid cancer 5.