Carmina, E., & Longo, R. A. (2023). Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. Journal of clinical medicine, 12(18). https://doi.org/10.3390/jcm12185921
Carmina E, Longo RA. Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. Journal of clinical medicine. 2023;12(18). doi:10.3390/jcm12185921
Carmina, Enrico, and Rosa Alba Longo. "Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs." Journal of clinical medicine, vol. 12, no. 18, 2023.
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Semaglutide cut weight in obese PCOS women unresponsive to lifestyle
Semaglutide cut body weight by at least 5% in 21 of 27 women with obese PCOS who had lost under 5% on a three-month lifestyle program, in a 2023 single-group study. Fasting insulin and insulin resistance also fell, including in women who lost less weight.
Key Findings
Twenty-seven obese women with PCOS (phenotype A), who lost less than 5% of body weight on a three-month lifestyle program, received semaglutide once a week for three months.
Women lost 7.6 ± 3 kg on average (range 2–12 kg), a BMI drop of 3.1 ± 1. Twenty-one lost over 5% of body weight; 6 (22.2%) lost less.
Twelve of the 15 women with increased fasting glucose (80%) reached normal fasting glucose. Fasting insulin and HOMA-IR decreased significantly (p < 0.01).
Twenty-one responders continued for three more months. Mean total weight loss reached 11.5 kg, mean BMI fell from 34.4 to 29.4, and menstrual disorders improved.
Nine patients (33%) reported morning nausea and two reported sporadic vomiting. No patient withdrew from therapy because of side effects.
Interpretation
This is a single-group treatment study of 27 women, all of whom received semaglutide. Every woman had the classic form of PCOS with obesity and a failed lifestyle program, so the results describe that group. HOMA-IR is a calculated index of insulin resistance. Women who did not respond had a significantly higher BMI than highly responsive women (mean BMI 40 versus 32, p < 0.01). The six-month results come from the 21 responders only. The authors note that other studies are needed.
RRM Context
The paper links obesity in PCOS to insulin resistance. PCOS now also goes by PMOS (Polyendocrine Metabolic Ovarian Syndrome). Restorative reproductive medicine treats weight, insulin resistance and cycle function as linked. The study tracked all three in responders.
Our editorial summary of this paper, not the article's abstract.
Abstract
In spite of the widespread use of lifestyle modifications programs, many patients with PCOS are obese and prevalence of obesity in PCOS remains high. In this study, we present the data on the use of semaglutide, an incretin mimetic drug, in obese PCOS patients who were unresponsive to a lifestyle modification program. Twenty-seven obese patients with a diagnosis of PCOS, who did not reduce their body weight by a lifestyle modification program, were included in this study and treated by semaglutide, 0.5 mg subcutaneously once a week. After three months of treatment, an improvement in body weight with a mean decrease in body weight of 7.6 kg and a mean BMI loss of 3.1 was observed, while very few side effects were reported. Almost 80% of the studied obese PCOS patients obtained at least a 5% decrease in their body weight. Only a few patients (22%) obtained a decrease in body weight lower than 5% and were considered non-responsive to semaglutide, at least at the used doses. These patients presented a more severe obesity than responsive patients. Independently of results on body weight, and in patients who did not obtain a 5% decrease in their body weight, insulin basal values decreased, and HOMA-IR improved. Fasting blood glucose normalized in 80% of semaglutide-treated IFG PCOS women. In patients who were responsive to semaglutide (weight loss > 5%), the treatment was continued for additional three months. Weight loss slowed but continued and, at the end of the six months of therapy, the mean body weight loss was 11.5 kg and mean BMI reduced from 34.4 to 29.4. A total of 80% of responsive patients normalized menstrual cycles. In conclusion, treatment with semaglutide, at low doses, significantly reduces body weight in almost 80% of obese PCOS patients who were unresponsive to a previous lifestyle plan. It is often associated with the normalization of menstrual cycles, and these important results are obtained with very few side effects.
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