Wegovy's heart benefits are not just linked with weight loss, new study suggests

By Eleanor Laise

Heart-failure patients with diabetes may shed fewer pounds on Wegovy but still get cardiovascular benefit, research finds

People with obesity-related heart failure and diabetes can get substantial heart-health benefits from the popular obesity drug Wegovy, even if they don't shed a lot of weight on the medication, according to new research.

Patients with a common type of heart failure and Type 2 diabetes who took Novo Nordisk's Wegovy for one year saw major improvement in their heart-failure-related symptoms and physical limitations, according to a study published Saturday in the New England Journal of Medicine. That improvement was on par with the benefits seen among patients without diabetes in comparable trial results released last year - despite the fact that Wegovy's weight-loss benefit was about 40% lower among the diabetes patients than among the earlier trial's participants.

The findings clearly suggest that while weight loss may be an important factor behind Wegovy's heart-failure benefits, "it's very likely that mechanisms beyond weight loss" are also playing a significant role, Dr. Mikhail Kosiborod, a cardiologist at Saint Luke's Mid America Heart Institute and lead author of the study, told MarketWatch. Semaglutide, which is the active ingredient in Wegovy as well as in Novo Nordisk's diabetes drug Ozempic, seems to have a direct effect on congestion and to significantly reduce inflammation, Kosiborod said.

"It's not all about weight loss," he said, adding that semaglutide is "fundamentally modifying" the disease process.

The results reinforce the drug's potential to "enhance cardiovascular care beyond weight management in people with obesity and this common form of heart failure that can greatly impact their daily living," Novo Nordisk said in a statement. Participants in the trial had heart failure with preserved ejection fraction, which is increasingly prevalent and often linked with obesity.

The results of the heart-failure study come as a broad swath of anti-obesity medications are being studied for uses that extend well beyond weight loss. Eli Lilly & Co. (LLY) is researching tirzepatide, the active ingredient in weight-loss drug Zepbound, in obstructive sleep apnea, heart failure, fatty-liver disease and other conditions. Obesity drugs are also being studied in conditions ranging from Alzheimer's disease to osteoarthritis and substance abuse. An older GLP-1 drug for diabetes, lixisenatide, may slow the progression of Parkinson's disease symptoms, according to a study released earlier this week. And the Food and Drug Administration last month approved the use of Wegovy to cut the risk of serious heart problems in people with obesity or who are overweight.

The growing list of potential uses for obesity drugs has been driving up expectations for broader insurance coverage and boosting analysts' sales projections. GLP-1 drugs such as Wegovy and related medications are expected to top $164 billion in combined sales in 2032, according to consensus estimates from Visible Alpha, up from $37.9 billion in 2023.

In the new semaglutide study, patients taking Wegovy lost an average 9.8% of their body weight after one year, compared with 3.4% for those on placebo. The patients taking Wegovy also saw significant improvements in their six-minute walking distance and blood pressure, among other measures, and were less likely than those on placebo to have a hospitalization or urgent visit for heart failure.

The study's findings are striking in part because there were several reasons to believe that heart-failure patients with diabetes might respond differently to treatment than those in the earlier non-diabetes study, including the fact that they tend to have more severe disease and generally lose less weight when taking anti-obesity medications, Kosiborod said.

Patients with diabetes are also more likely to take a class of drugs called SGLT2 inhibitors, which can reduce heart-failure risks. But the study found that patients taking SGLT2 inhibitors got about as much heart-failure benefit as patients not taking the medications, Kosiborod said. That suggests that semaglutide and SGLT2 inhibitors have complementary mechanisms of benefit and could potentially be used as a combination therapy for people with heart failure, he said.

Novo Nordisk's American depositary receipts (NVO) have gained 22% in the year to date, while the S&P 500 is up 9%.

-Eleanor Laise

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04-06-24 1616ET

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