Semaglutide as Treatment for Obesity in Adolescents

Abstract

Background: Semaglutide was recently approved to treat obesity in adolescents. Main objective: To provide a critical appraisal of semaglutide as anti-obesity agent in adolescents. Methods: Pubmed search up to May 19, 2023. Search terms were obesity, semaglutide, safety, phentermine/topiramate, liraglutide, dulaglutide, exenatide. Clinical trials, prospective and observational studies were included. Results: The STEP TEENS was a double-blind, randomized trial that evaluated semaglutide 2.4 mg/week in addition to lifestyle changes in 201 adolescents (62% women) with obesity with mean body mass index (BMI) 37.0 kg/m2. After 68 weeks, difference between semaglutide and placebo in reduction of BMI (the primary outcome) was -16.7% (95% CI, -20.3 to -13.2). Corresponding difference in weight loss was -17.7 kg (95% CI, -21.8 to -13.7). Proportions of subjects who had ≥5% weight loss at 68 weeks were 73% and 18% with semaglutide and placebo groups, respectively. In the semaglutide group, reduction in BMI was evident (>5%) after 3 months, reached a nadir in 52-58 weeks then plateaued. Overall, the safety profile of semaglutide in adolescents mimics that in adults, except for higher incidence of gall bladder disease, and allergic reactions (rash and urticaria) in adolescents. Premature discontinuation of treatment due to adverse effects occurred in 5% of semaglutide-treated patients compared with 4% of placebo-treated subjects. Conclusions: Semaglutide is a promising addition to pharmacological therapy of obesity in adolescents. Further studies are needed to demonstrate its long-term efficacy and safety, particularly in various ethnic minorities and in patients with concomitant type 2 diabetes.