Pharmacy Daily | How Ozempic can change arthritis

AS the poster child of one of the most hyped drug classes of this century, Ozempic (semaglutide) has the potential to change the lives of millions of people living with type 2 diabetes, for which it is primarily indicated, and obesity and it associated metabolic diseases.

But with many rheumatological conditions made worse by obesity, notably osteoarthritis, rheumatoid arthritis and psoriatic arthritis, there is potentially much to gain by patients and their treating physicians from the drug, said Melbourne rheumatologist and Arthritis Australia medical director Dr David Liew.

"Much of the refractory pain and suffering from these conditions might be attributable to obesity, raising questions about how GLP-1 agonists, which also include Mounjaro (tirzepatide), can influence the diseases we treat," Dr Liew explained.

In knee osteoarthritis, which affects around two million Australians, obesity has long been identified as a key factor and effective pharmacotherapeutic approaches are lacking.

A recent clinical trial in osteoarthritis patients comparing semaglutide versus placebo showed meaningful gains in function and pain reduction for those taking semaglutide, with Dr Liew suggesting it might be one of the key interventions leading to benefit in this condition.

"Even with such data, many issues will still arise," he said.

"Apart from neglect of still-effective non-pharmacological approaches, such as exercise, diet and physical therapy, access to GLP-1 agonist therapy will remain a large question, particularly given existing costs and globally constrained supply."

However, he pointed to some health economic modelling suggesting that, in certain situations over a five year horizon, a GLP-1 agonist intervention could make pharmacoeconomic sense in knee osteoarthritis.

As for other conditions, a US study found that patients with rheumatoid arthritis taking semaglutide or tirzepatide not only recorded weight loss and improved HbA1c, but also improvements in pain and flare ups.

While the benefits can be achieved with any weight loss method resulting in a body weight reduction of 5% or more, GLP-1 agonists have had greater success than other methods.

Pain and disease activity is often incompletely managed in obese rheumatology patients, and readily actionable therapies have been hard to implement in the past, said Dr Liew, raising the possibility that rheumatologists will be discussing the option of GLP-1 agonists with their patients.

However, he cautioned, it depends on many things, including better quality research data.

"There are incompletely answered questions about the long-term game plan for such patients - will they need indefinite treatment to sustain benefit, and will that be justifiable? And will such therapy be tolerable?

"Only time will tell how GLP-1 agonist strategy will be implemented for rheumatology patients," said Dr Liew. KB