In patients with obesity and knee osteoarthritis, once-weekly semaglutide (2.4 mg) significantly reduced body weight and pain compared to placebo, though it was associated with gastrointestinal side effects.
PICO Summary
Population:
Adults with obesity (BMI ≥30) and moderate knee osteoarthritis, with an average age of 56 years and primarily female representation (81.6%).
Intervention:
Once-weekly subcutaneous semaglutide, 2.4 mg, combined with diet and exercise counselling.
Comparison:
Placebo with the same diet and exercise regimen.
Outcome:
• Efficacy: Semaglutide group achieved a 13.7% weight reduction and a 41.7-point decrease in WOMAC pain score versus 3.2% and 27.5 points in the placebo group (P < 0.001).
• Safety and Tolerability: Adverse events led to discontinuation in 6.7% (semaglutide) vs. 3.0% (placebo) groups, primarily due to gastrointestinal issues.
Clinical Summary
Main Finding:
Semaglutide markedly improved weight loss and knee osteoarthritis pain management, showing significant reductions in both body weight and WOMAC pain scores.
Clinical Relevance:
This trial underscores semaglutide’s dual benefit for patients with obesity and knee osteoarthritis by reducing weight and alleviating pain, potentially lessening NSAID use and thus reducing associated risks. Semaglutide’s GI side effects remain a consideration for patient tolerability.
Study Overview:
• Type of Study: Double-blind, randomised, placebo-controlled trial.
• Sample Size & Population: 407 participants across 61 sites.
• Intervention Duration & Doses: 68 weeks with dose escalation to 2.4 mg at week 16.
• Comparison: Placebo with lifestyle modifications.
Outcomes:
• Primary Measure (Weight Reduction): 13.7% reduction in semaglutide group vs. 3.2% in placebo.
• Secondary Measure (WOMAC Pain): 41.7-point reduction with semaglutide vs. 27.5 with placebo.
Overall physical health scores also improved more with semaglutide, with an increase of 12.0 points versus 6.5 points in the placebo group. Participants on semaglutide reduced their use of painkillers (NSAIDs and acetaminophen) more significantly than those in the placebo group.
• Safety Profile: Gastrointestinal issues were prominent, causing discontinuation in a small percentage.
Considerations:
While findings support semaglutide’s utility in weight and pain reduction for knee osteoarthritis, the trial’s limitations include a lack of post-treatment imaging and biomarker assessment, as well as unassessed adherence to diet and physical activity. The high incidence of gastrointestinal effects also suggests that patient tolerability needs to be carefully considered.
Reference:
Bliddal, H., et al. (2024). New England Journal of Medicine, 391(17): 1573-1583. doi:10.1056/NEJMoa2403664
Disclosure:
This article on Hormone Insight was created with assistance from both humans and AI. The human expert editor reviewed the article before publication to ensure accuracy, quality, and clarity.
