What are the indications and usage for Wegovy (semaglutide) in treating obesity?

Indications and Usage for Wegovy (Semaglutide) in Treating Obesity

Wegovy (semaglutide 2.4 mg) is indicated for chronic weight management in adults with a BMI ≥30 kg/m² or ≥27 kg/m² with at least one weight-related comorbid condition, as an adjunct to a reduced-calorie diet and increased physical activity. 1

Patient Eligibility Criteria

• BMI-based criteria:

  • BMI ≥30 kg/m² (obesity) OR
  • BMI ≥27 kg/m² (overweight) with at least one weight-related comorbidity 2, 1

• Weight-related comorbidities that qualify:

  • Type 2 diabetes
  • Hypertension
  • Dyslipidemia
  • Obstructive sleep apnea
  • Cardiovascular disease 2, 3

Efficacy and Clinical Benefits

Wegovy has demonstrated superior efficacy compared to other weight management medications:

• Weight loss outcomes:

  • Mean weight loss of 14.9% at 68 weeks (vs. 2.4% with placebo) in STEP 1 trial 2
  • Up to 16.0% weight loss when combined with intensive lifestyle intervention in STEP 3 trial 2
  • 77.1% of patients achieve ≥5% weight loss at 104 weeks 4
  • 64.9% of patients achieve ≥10% weight loss (vs. 12.3% with placebo) 2
  • 46.1% of patients achieve ≥15% weight loss (vs. 5.4% with placebo) 2

• Cardiometabolic benefits:

  • Reduced risk of cardiovascular events in patients with obesity and cardiovascular disease (hazard ratio 0.80; 95% CI, 0.72-0.90) in the SELECT trial 2
  • Improvements in blood pressure, atherogenic lipids, and physical function 5
  • Reduction in abdominal visceral fat area by 40.0% (vs. 6.9% with placebo) 6

Administration and Dosing

• Route: Subcutaneous injection, once weekly

• Dose titration schedule:

  1. Start at 0.25 mg weekly for 4 weeks
  2. Increase to 0.5 mg weekly for 4 weeks
  3. Increase to 1.0 mg weekly for 4 weeks
  4. Increase to 1.7 mg weekly for 4 weeks
  5. Maintenance dose: 2.4 mg weekly 3

• Required concurrent therapy: Must be used in conjunction with reduced-calorie diet (typically 500-kcal deficit) and increased physical activity (150 minutes/week) 2

Safety Considerations and Adverse Effects

• Common adverse effects:

  • Gastrointestinal disorders (most common): nausea, vomiting, diarrhea, constipation 2, 3
  • Most adverse effects are mild to moderate and occur during dose escalation 4

• Serious adverse events:

  • Increased risk of pancreatitis and gallbladder disease 2, 3
  • 38% higher risk of serious adverse events compared to placebo (95% CI, 1.10-1.73) 2

• Contraindications:

  • Personal or family history of medullary thyroid cancer
  • Multiple endocrine neoplasia syndrome type 2 2

Long-term Considerations

• Duration of therapy:

  • Intended for long-term use
  • Significant weight regain occurs after discontinuation (11.6% of lost weight regained) 2, 3
  • NICE recommends a maximum treatment duration of 2 years in the UK 7

• Monitoring requirements:

  • Regular assessment of weight response
  • Screening for malnutrition in patients with significant weight loss 2
  • Monitoring for gallbladder disease and pancreatitis 2, 3

Comparative Efficacy

• Semaglutide 2.4 mg vs. liraglutide 3.0 mg:

  • Semaglutide achieves greater weight loss (14.9% vs. 8.0%) 2, 3
  • Semaglutide has lower rates of gastrointestinal adverse events 2
  • Semaglutide is administered weekly vs. daily for liraglutide 3

• Special populations:

  • In East Asian populations, semaglutide 2.4 mg achieved 13.2% weight loss (vs. 2.1% with placebo) 6
  • In patients with type 2 diabetes, semaglutide 2.4 mg achieved 9.6% weight loss (vs. 3.4% with placebo) 5

Clinical Pearls

• Gradual dose titration is essential to mitigate gastrointestinal side effects 3
• Weight regain is common after discontinuation, emphasizing the need for long-term therapy 2, 3
• Semaglutide should be prioritized over other anti-obesity medications for most patients due to its superior efficacy 2
• For patients with type 2 diabetes, semaglutide offers dual benefits of glycemic control and weight management 2