Semaglutide reduces body weight and pain symptoms in obese patients with knee osteoarthritis

1. In this randomized controlled trial, once-weekly semaglutide led to significant weight loss compared to placebo over 68 weeks in obese patients with knee osteoarthritis.

2. Knee pain scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale significantly decreased with semaglutide compared to placebo.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Knee osteoarthritis is associated with substantial morbidity and mortality, particularly impacting quality of life. Obesity is associated with an increased symptom burden in osteoarthritis. Semaglutide has previously been demonstrated to result in lower body rate in patients with obesity, but the impact on osteoarthritis symptoms is unclear. Accordingly, this randomized controlled trial evaluated the effect of once-weekly semaglutide in adults with obesity and knee osteoarthritis. Outcomes of interest included weight loss and patient symptoms, including pain scores through WOMAC. Participants receiving semaglutide experienced significant improvements in both weight reduction and knee pain relief compared to the placebo group. Improvements in physical function and a decrease in the use of pain medication were also observed among participants treated with semaglutide. Limitations of the study include the lack of imaging follow-up to assess knee structural changes and a predominance of female participants, which may limit the generalizability of the findings. In summary, the results of this study suggest that once-weekly semaglutide may improve symptoms of knee osteoarthritis in patients with obesity.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: The Semaglutide Treatment Effect in People with Obesity (STEP) 9 trial was a 68-week, double-blind, randomized controlled trial evaluating once-weekly semaglutide (2.4 mg) for weight management and knee osteoarthritis symptoms in obese adults. Eligible participants, aged 18 and older with a BMI of 30 or higher and moderate knee osteoarthritis, were randomly assigned in a 2:1 ratio to receive semaglutide or placebo alongside lifestyle counseling. The primary endpoints were changes in body weight and WOMAC pain scores. At 68 weeks, the semaglutide group had a mean weight reduction of 13.7%, compared to 3.2% in the placebo group (p<0.001). WOMAC pain scores improved by 41.7 points in the semaglutide group versus 27.5 points in the placebo group (p<0.001), indicating a significant reduction in knee pain. Physical function, assessed by the SF-36 Health Survey, improved more in the semaglutide group, with a mean increase of 12.0 points compared to 6.5 points for placebo (p<0.001). Adverse events were similar between groups, with 10.0% of semaglutide users and 8.1% of placebo users experiencing serious adverse events. However, gastrointestinal issues, such as nausea and vomiting, were more common in the semaglutide group, leading to a discontinuation rate of 6.7% compared to 3.0% in the placebo group. These side effects were managed by dose adjustments as needed. Overall, this study supports the use of semaglutide as an effective adjunctive therapy for weight management and pain relief in obese adults with knee osteoarthritis, showing significant benefits in weight loss, pain reduction, and physical function, with a generally favorable safety profile aside from known gastrointestinal side effects.

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