Is Wegovy (semaglutide) safe for use in patients with muscular dystrophy?

Safety of Wegovy (Semaglutide) in Patients with Muscular Dystrophy

Wegovy (semaglutide) should be used with caution in patients with muscular dystrophy due to potential concerns about muscle mass loss, though there is insufficient direct evidence specifically addressing this population.

Considerations for Muscular Dystrophy Patients

Cardiac Considerations

• Patients with muscular dystrophy, particularly Duchenne muscular dystrophy (DMD), have significant cardiac involvement that requires careful management:
  • DMD patients develop cardiomyopathy that contributes significantly to morbidity and mortality 1
  • ACE inhibitors/ARBs are recommended by age 10 in DMD patients to delay onset of left ventricular dysfunction 1
  • Cardiac management should be more aggressive in muscular dystrophy patients due to higher mortality from cardiomyopathy 1

Muscle Mass Considerations

• Muscle preservation is critical in muscular dystrophy:
  • Therapeutic strategies for muscular dystrophy often focus on increasing or preserving muscle mass 2
  • Recent research shows variable effects of semaglutide on muscle mass:
    • One study found that oral semaglutide reduced body fat without significantly affecting muscle mass in type 2 diabetes patients 3
    • However, another study in HIV patients showed a 9.3% decrease in psoas muscle volume with semaglutide use, though physical function was maintained 4

Semaglutide Management Considerations

Dosing and Titration

• If used, follow standard titration protocol to minimize adverse effects 5:
  • Weeks 1-4: 0.25 mg weekly
  • Weeks 5-8: 0.5 mg weekly
  • Weeks 9-12: 1.0 mg weekly
  • Weeks 13-16: 1.7 mg weekly
  • Week 17+: 2.4 mg weekly (maintenance)

Monitoring Recommendations

• Regular monitoring is essential:
  • Document weight and BMI every 6 months 5
  • Monitor cardiac function with echocardiography and CMR as recommended for muscular dystrophy patients 1
  • Assess muscle strength and function regularly
  • Monitor for gastrointestinal adverse effects, which are common (nausea 40%, vomiting 16%) 5

Potential Benefits

• Semaglutide may offer benefits for some muscular dystrophy patients:
  • Weight management in overweight/obese patients with muscular dystrophy
  • Potential cardiovascular benefits, as GLP-1 receptor agonists like semaglutide are recommended for reducing cardiovascular events in high-risk patients 1
  • One case report suggests potential benefit in hyperkalemic periodic paralysis, a different muscle disorder 6

Clinical Decision Algorithm

1. Assess baseline status:

   • Evaluate cardiac function (echocardiography, CMR if indicated)
   • Document baseline muscle strength and function
   • Measure body composition if possible (fat vs. muscle mass)

2. Risk-benefit analysis:

   • Consider if weight management benefits outweigh potential risks
   • Higher priority for patients with significant obesity complicating muscular dystrophy management
   • Lower priority if patient is at healthy weight or underweight

3. If proceeding with treatment:

   • Start at lowest dose (0.25 mg weekly) and titrate slowly
   • Monitor weight, muscle strength, and cardiac function regularly
   • Discontinue if significant muscle weakness develops or cardiac function deteriorates

Cautions and Contraindications

• Exercise caution in:

  • Patients with advanced muscular dystrophy
  • Patients with significant cardiac involvement
  • Patients with dysphagia or gastrointestinal dysfunction (common in muscular dystrophy)

• Consider alternatives if:

  • Patient is underweight or has difficulty maintaining weight
  • Patient has significant cardiac dysfunction
  • Patient has history of pancreatitis or gallbladder disease 5

Knowledge Gaps and Research Needs

• No specific studies of semaglutide in muscular dystrophy populations
• Unknown effects on disease progression in muscular dystrophy
• Unclear interactions with common muscular dystrophy treatments like corticosteroids
• Need for research on effects of GLP-1 agonists on dystrophic muscle

While semaglutide shows promise for weight management and cardiovascular risk reduction, its use in muscular dystrophy requires careful consideration of the potential impact on muscle mass and function, with close monitoring if prescribed.