With the growing popularity of new weight loss drugs, doctors emphasize potential risks

When researchers discovered that a class of drugs initially used to treat type 2 diabetes could also bring about weight loss, the drugs Victoza and Ozempic gained popularity as treatment options for obesity.

Given as daily or weekly injections, these drugs called GLP-1 RAs help people produce insulin and lower the amount of sugar in their blood. First approved for use in patients with type 2 diabetes in 2005 by the US Food and Drug Administration, the drugs were quickly noted to promote weight loss.

The FDA, in 2014, later approved a GLP-1 RA for chronic weight management. Additional drugs in the class have already been approved for weight loss.

Of the nearly 35 million Americans with type 2 diabetes, more than one in 10 are estimated to be taking these medications in 2019, according to the Journal of the American Medical Association.

“I prescribe these medications 10 times a day,” said Dr. Amanda Velazquez, director of obesity medicine at Cedars-Sinai Medical Center, told ABC News.

“Obesity is a chronic relapsing disease,” added Velazquez and said that the weight-loss effects of the drugs wear off after the drug is discontinued.

PHOTO: The diabetes drug Ozempic in a pharmacy in the Netherlands on November 10, 2022.

The diabetes drug Ozempic at a pharmacy in the Netherlands on November 10, 2022.

Hollandse Hoogte/Shutterstock

Novo Nordisk, the pharmaceutical company that makes Ozempic, Victoza and another drug called Wegovy – which is specifically intended for weight loss – said last December: “While we recognize that some healthcare professionals may be prescribing Ozempic to patients whose goal is to lose weight , it is up to the clinical discretion of each healthcare professional to choose the best treatment approach for their patients.”

During the fall, there were intermittent shortages of various strengths of Ozempic and Wegovy.

“There is an overall high demand, more awareness of the drugs because of their effectiveness, and shortages in the supply chain to make the drug from manufacturers,” Velazquez said.

The off-label use of drugs may be contributing to this shortage.

“It’s very frustrating for everyone,” said Dr. Heather Sateia, an assistant professor of medicine at Johns Hopkins Hospital, told ABC News. “Pharmacies are so understaffed that they don’t let people know when stock is back, so it’s like a scavenger hunt — time-consuming and anxiety-provoking for patients.”

A recent University of Montpellier study published in Diabetes Care looked at patients with type 2 diabetes treated with GLP-1 RAs from 2006 to 2018 and identified a link between long-term use of these medications and an increased likelihood of thyroid problems. Cancer. Specifically, the study found that people who took the drugs for one to three years were 58% more likely to develop thyroid cancer. Medullary thyroid cancer, a rare form of the disease, carries an even higher risk, according to the study.

“The latest findings provide interesting additional data for this clinical discussion, although they are not independent enough to establish a new standard of screening,” Dr. Erik K. Alexander, Chief of the Thyroid Section in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital, told ABC News. “[These drugs] should only be used when the benefit of treatment outweighs the known or suspected risk, and this assessment should be continually reconsidered by each patient with their physician on a regular basis.”

45,000 Americans are diagnosed with thyroid cancer, but notably it’s not a death sentence according to the American Cancer Society. With surgery and therapy, the 5-year survival is 98%, but this greatly depends on the type of thyroid cancer and the stage of the disease. Medullary thyroid cancer has a relatively poor prognosis compared to other types, according to the American Cancer Society.

In a statement, Novo Nordisk says that extensive data from randomized trials, long-term studies and real-world evidence “have not shown a causal relationship between the use of GLP-1 receptor agonists and the risk of thyroid tumors.”

The company “remains confident in the risk-benefit profile of its products and remains committed to ensuring patient safety,” the statement said.

Medications can sometimes cause nausea, pain at the injection site, and inflammation of the pancreas. Some patients taking concomitant diabetes medications may also experience low blood sugar levels.

Currently, patients are monitored every 3-4 months with liver, diabetes, kidney, cholesterol and electrolyte tests. Currently, thyroid testing is not recommended.

“The thyroid cancer data certainly got me thinking,” Sateia said. “There is currently no recommendation for thyroid ultrasound or serum calcitonin monitoring, but we are watching for changes in these recommendations. I suspect we will see a change in this soon.”

“It probably wouldn’t change the way it’s prescribed, but it’s something to be aware of,” said Dr. Yufei Chen, assistant professor of general surgery at Cedars-Sinai Medical Center, told ABC News.

Natalie S. Rosen, MD, is a physician in the Hematology Department of Oncology and Oncology at New York-Presbyterian Columbia and former member of the ABC News Medical Unit.

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