Conceptual image of a multiple sclerosis neuron.
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Add multiple sclerosis to the list of conditions the new weight loss drugs may help treat. Novel diabetes drugs like Ozempic and Wegovy initially showed promise in weight loss and have since been marketed and widely used for this indication. However, a new study based on real world data (RWD) describes a possible protective effect against multiple sclerosis (MS) for some of these medications, including semaglutide (Novo Nordisk’s Ozempic, Wegovy, and Rybelsys) and dulaglutide (Eli Lilly’s Trulicity).

Repurposing such drugs for this disease can only be much welcomed news for the MS community, it could also be a further boost for the thriving global market for new anti-obesity medications. Goldman Sachs Research has estimated this market had already reached $6 billion and it could grow by more than 16 times to $100 billion by 2030.

The study was published in Therapeutic Advances in Neurological Disorders. The lead author is Afsaneh Shiran of the Washington University School of Medicine.

The team analyzed data from FAERS (the FDA Adverse Event Reporting Database) between 2003 and 2023 to explore associations between MS and weight loss-inducing drugs. FAERS is a publicly available database containing information on spontaneous reporting of adverse events (AEs) and medication errors. 

They investigated both anti-diabetic medications with weight loss-inducing effects, including semaglutide, dulaglutide, liraglutide, tirzepatide, empagliflozin, canagliflozin, dapagliflozin, and metformin, as well as other weight loss-inducing drugs, including orlistat, phentermine, bupropion, topiramate, zonisamide, amphetamine, and naltrexone.

Their analysis of the RWD found an inverse relationship between the use of certain weight loss medications, though not all. Semaglutide, dulaglutide, empagliflozin, and metformin were all linked to lower rates of MS development. 

The team suggests their findings point to repurposing anti-diabetic weight loss-inducing drugs including semaglutide, dulaglutide, and liraglutide (glucagon-like peptide-1 receptor agonists), empagliflozin (a sodium-glucose cotransporter-2 inhibitor), and metformin (a biguanide), for MS. 

While not all weight loss medications showed the same favorable effect, it seems that the effects of these medications go beyond weight loss to possible anti-inflammatory and/or neuro-protective results.

An estimated 2.8 million people live with MS worldwide (35.9 per 100,000 population). MS prevalence has increased in every world region since 2013 and twice as many women have the disease as men.

As these authors note, the relationship MS and obesity is multi-faceted. Obesity is a driver of systemic and local inflammation. Several studies have demonstrated that early childhood or adolescent obesity increases the risk of MS. Obesity can also be an MS disease modifier. Newly diagnosed patients with MS who are obese tend to experience more severe disease and poorer outcomes. Moreover, obesity has been reported to be associated with a less favorable response to disease-modifying therapies.

But obesity, they note, is believed to share inflammatory components with MS. Excess macronutrients in adipose tissues trigger the release of inflammatory mediators, including leptin, tumor necrosis factor-α, and interleukin-6, while decreasing the production of adiponectin (an anti-inflammatory adipokine), predisposing to a pro-inflammatory state and oxidative stress. Obesity can thus be considered as a state of low-grade chronic inflammation. 

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