What is Semaglutide?
Semaglutide is a glucagon-like peptide-1 receptor agonist. It replicates the functioning of the hormone glucagon-like peptide-1, which helps with the maintenance of appetite and is used to deplete blood sugar in individuals with type 2 diabetes and to help people with obesity or a medical condition to lose weight [1, 2, 3, 4, 5, 6].
Two forms of Semaglutide are available – one is Ozempic, currently approved by the US Food and Drug Administration (FDA) to lower blood sugar in people with type 2 diabetes alongside dietary modification and physical activity. The other form, Wegovy, is approved by the FDA for patients 12 years of age and older who are obese or who are overweight due to medical conditions. It is approved as an adjunct to diet and physical activity for weight loss for such patients. Both forms of Semaglutide are delivered via subcutaneous injection [1].
Semaglutide is thought to direct the pancreas to release the right amount of insulin into the blood when blood glucose levels are high. Because cells cannot use insulin, insulin helps drop the blood glucose to a normal level by causing glucose to be stored in the liver and transported to other tissues for utilisation or storage. Semaglutide can also slow down food’s pace as it passes through the stomach, potentially contributing to weight loss [6, 7].
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease marked by progressive inflammation of synovial tissues in the joints. Presenting with symptoms of marked joint pain, swelling, stiffness and redness, it is an autoimmune-mediated inflammatory disorder [8, 9].
RA is systemic. It can inflame all the tissues in the body, not just the joints. It can inflict damage on the heart the lungs, and other organs, as well as flesh and bone such as muscles, cartilage and ligaments [9].
This condition is a relatively progressive disease that leads to intense morbidity and mortality, characterised by chronic inflammation and secondary destruction of the joints [10].
The exact mechanism bringing about RA is not known but it is postulated to manifest in genetically susceptible individuals following exposure to environmental or infectious triggers. [11].
The incidence of RA is greater in women than in men, and the risk of developing the disease increases with age, such that about 1 in every 100 persons worldwide has rheumatoic arthritis [11, 12].
Semaglutide and Rheumatoid Arthritis
Differences
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used to treat type 2 diabetes mellitus and is also approved for weight loss [13, 14]. It works by mimicking the GLP-1 hormone, causing your body to produce more insulin, lowering your blood sugar levels, and signalling fullness to your brain [14].
RA, on the other hand, is an autoimmune disease that primarily affects the joints, causing inflammation, pain, and potential joint damage. It is not related to blood sugar levels or insulin production, which are the primary targets of Semaglutide.
While both conditions can have systemic effects and may impact a person's overall health, they are fundamentally different in terms of their causes, symptoms, and treatment approaches.
It's important to note that while Semaglutide is effective in managing type 2 diabetes and aiding in weight loss, it should not be used as a treatment for RA unless directed by a healthcare provider.
Can Semaglutide help with inflammation in Rheumatoid Arthritis?
Semaglutide, a centrally acting anti-diabetic medication, can have anti-inflammatory activities across multiple diseases and is being investigated for its effect on RA.
In one recent study of acute lung injury (ALI), Semaglutide severely dampened lung injury, and lowered the production of the two key inflammatory cytokines TNF-α and IL-6, which play a major role in RA [15]. Thus, it could have a similar anti-inflammatory effect on the latter illness; while there are no studies directly addressing Semaglutide in RA patients yet, they could come in the future.
Of importance, Semaglutide was found to inhibit the HDAC5-mediated NF-P signalling pathway [15]. The NF-kB pathway is also widely recognised to be pivotal in the RA inflammatory response [16], which would be consistent with it being one of the mechanisms of action of Semaglutide in the inflammation of RA.
Although those findings are promising, much more research will be required before it can be said with certainty that the drug has a role in the treatment of RA, including placebo-controlled clinical trials in RA patients. Until then, RA patients must follow their provider’s diagnostic and treatment recommendations.