Subcutaneous Semaglutide Suppresses Appetite, Reduces Excess Energy Intake in Patients with Obesity

Data from a phase 1 trial presented at the 28th European Congress on Obesity (ECO 2021) is shedding light on the effects of semaglutide on gastric emptying, appetite, and energy intake among patients with obesity.

While data from the STEP program has underlined the effects of 2.4 mg subcutaneous semaglutide as a treatment for obesity, this study from the European Association for the Study of Obesity’s ECO 2021 meeting demonstrate use of semaglutide was associated with a 35% reduction in mean energy intake and greater control of eating among patients with obesity.

"Control of appetite and reduced frequency and strength of food cravings are important for weight management in people living in obesity, especially in a society which promotes unhealthy lifestyles and overeating,” noted investigators in a statement from the European Association for the Study of Obesity.

Led by Dorthe Skovgaard, MD, PhD, and sponsored by Nov Nordisk, the current study was designed as double-blind, parallel-group, phase 1 trial randomizing patients to subcutaneous semaglutide or placebo. For the purpose of analysis, investigators assessed gastric emptying using paracetamol absorption following a standardized breakfast and energy intake was measured during ad libitum lunch. Investigators also noted plans to assess patient-reported appetite ratings and Control of Eating Questionnaire responses.

Conducted at a single center in Germany, the trial enrolled 72 patients for inclusion who received treatment for 20 weeks and followed for an additional 7 weeks. Patients included in the trial were between 18-65 years of age and had a BMI of 30-45 kg/m2. Exclusion criteria included weight loss of 5% or greater in the prior 90 days, presence of gastrointestinal disorders or symptoms, and use of weight-lowering drugs or drugs that could cause weight gain in the prior 12 months.

Of note, patients randomized to semaglutide underwent a 16-week dose-escalation followed by 2.4 mg semaglutide for 5 doses. In total, patients randomized to semaglutide received 21 doses during the 20-week treatment period.

Upon analysis, investigators found the area under the concentration-time curve for paracetamol 0-5 hours following a standardized meal was increased by 8% with semaglutide versus placebo (non-significant when corrected for week 20 body weight; P=.12). No difference was observed when assessing AUC for maximum paracetamol concentration 0-1 hours following a standardized meal or in time to maximum observed paracetamol concentration.

Further analysis indicated ad libitum energy intake was 35% lower among patients receiving semaglutide versus those receiving placebo (1736 vs 2676 kJ; estimated treatment difference −940 kJ; P <.0001). When assessing patient-reported information, investigators found semaglutide use was associated with reduced hunger, prospective food consumption, and increased fullness and stately when compared against placebo (P for all <.02). Using questionnaire data, results suggested semaglutide was associated with better control of eating and fewer food cravings versus placebo (P <.05).

Investigators also pointed out semaglutide was associated with a 9.9% reduction in body weight compared with a reduction of 0.4% with placebo. Additionally, safety analyses revealed the safety profile was consistent with the known profile of semaglutide.

This study, “Semaglutide 2.4 mg Once Weekly Reduces Appetite, Reduces Energy Intake and Improves Control of Eating in Subjects with Obesity,” was presented at ECO Online 2021.