Watch out for Weight Loss Medications

 

Watch out for Weight Loss Medications

Studies have found that people who use common weight loss and diabetes medications are more likely to develop gastroparesis.

Injected drugs that treat diabetes and obesity increase the risk of a rare but serious side effect: stomach paralysis, according to new data on real-world use of the drugs.

At least three new studies, based on large sets of patient records, show that the risk of being diagnosed with gastroparesis, or gastroparesis, is higher for people who take GLP-1 agonists than for those who don't.

The studies have not been reviewed by outside experts or published in medical journals, so the data are preliminary. Two were presented on Saturday at the Digestive Disease Week 2024 Medical Conference in Washington; The third is scheduled to be presented on Monday.

Injected medications called GLP-1 agonists are in high demand because they have proven effective for weight loss. In clinical trials, stronger drugs like Wegovy and Zepbound have been shown to help people lose at least 10% of their starting weight. Studies have also concluded that it has benefits for the heart as well as waist circumference. Pharmaceutical company Novo Nordisk said 25,000 people start the Wegovy app weekly in the United States alone.

These medications reduce hunger by slowing the passage of food through the stomach. They also help the body release more insulin and help send signals to the brain that reduce cravings.

However, in some people, these medications can also cause unpleasant or severe bouts of vomiting, which may require medical attention. They can also slow the stomach to the point that medical tests show a condition called gastroparesis.

Doctors say that gastroparesis will most often improve after stopping the medication. However, some people say their condition did not improve even months after stopping the medication, resulting in life-changing consequences.

Measuring the risk of gastroparesis

In new studies, the risk of gastroparesis appears to be rare but consistent. Compared with similar people who did not take GLP-1 medications, those who took them were 50% more likely to be diagnosed with the condition.

One study by researchers at University Hospitals in Cleveland used records collected by the TriNetX database, including millions of patient records from 80 contributing healthcare organizations. The analysis focused on adults who were obese, with a body mass index above 30, but who had not been diagnosed with diabetes, gastroparesis, or pancreatitis at least six months before starting GLP-1 medication. Records from more than 286,000 patients were included in the study.

Diabetes itself can also increase the risk of gastroparesis, especially if a person's blood sugar is not well controlled for a long period.

Among people who were prescribed a GLP-1 weight-loss drug — such as liraglutide (called Ozempic and Wegovy), exenatide (Byetta), and liraglutide (Victoza) — 10 out of every 10,000, or 0.1%, were diagnosed with gastroparesis in 10,000 people, after at least six months. By comparison, 4 out of 10,000 people, or 0.04%, were matched in the database based on age, sex, race, and other factors, but those who did not take GLP-1 medication developed the condition.

The statistically significant difference amounted to a 52% increased risk of gastroparesis while taking GLP-1.

A second study, led by researchers at the University of Kansas, also used records from the TriNetX Research Network database. It included patients who were prescribed GLP-1 drugs for diabetes or obesity between December 2021 and November 2022 and compared them with people who had diabetes or obesity and were seen by a doctor during the same time frame but were not prescribed them. GLP-1 drug. Records from nearly 300,000 patients were included in the study.

Compared with those who did not take GLP-1 medication, those who did were about 66% more likely to be diagnosed with gastroparesis. This study found that 0.53% of patients taking GLP-1 drugs were diagnosed with gastroparesis or about 1 case of gastroparesis for every 200 people taking the drugs.

People taking GLP-1 drugs were also more likely to have nausea and vomiting or gastroesophageal reflux disease (GERD) and to be prescribed a proton pump inhibitor. They were more likely to have their gallbladder removed and develop drug-induced pancreatitis.

"Even though these medications are effective and should be used for the right reason, we just want to caution everyone that if you decide to start taking them, be prepared that you have a 30 percent chance of potentially experiencing gastrointestinal side effects," said study author Dr. Pratik Sharma, a professor of medicine at the University of Kansas, said the drug may have to be discontinued.

Some side effects of medications may also diminish over time as people get used to their doses. This is one reason why doctors start with a low dose of the drug and work up to higher amounts over time.

Sharma noted that the study included people with diabetes in both the group taking the GLP-1 drugs and the comparison group, and they still found a higher incidence of gastroparesis in those taking the drugs, suggesting that diabetes alone was not the cause. Increased risk.

"The only difference between these two groups was the medication," he said.

"We showed that all gastrointestinal side effects or symptoms, such as nausea, vomiting, and gastroparesis, were significantly higher in GLP-1 recipients than controls," said Sharma, president-elect of the American Gastroenterology Association for Endoscopy.