Evidence ‘growing’ for GLP-1 RA use in asthma management: Expert

People who suffer from asthma could benefit from the use of semaglutide, or glucagon-like peptide-1 receptor agonists (GLP-1 RAs), according to a new Danish study.
 
Funded by drug manufacturer Novo Nordisk, the study adds to the growing list of medical conditions that could potentially benefit from semaglutide, which, apart from its broad use in weight loss and diabetes management, is also suggested to lower risks for conditions such as dementia, mental health issues, and heart disease.
 
Presented last week at the European Congress on Obesity in Turkey, the study from Copenhagen University followed 27,523 people all diagnosed with asthma.
 
Of those, 49% had comorbid overweight or obesity, 61% with type 2 diabetes, and 26% with both conditions.
 
Compared with the year before GLP-1 RA treatment, it was associated with a 26% lower asthma exacerbation rate overall, and a 14% drop in the use of inhaler relievers.
 
The study authors said the results show ‘significant reductions’ in exacerbation burden and reliever use, exposure to inhaled corticosteroids and pneumonia events, ‘irrespective of whether the drugs were being used to treat obesity or type 2 diabetes’.
 
The authors also noted that there is a ‘high chance that the weight loss is a major contributor to these results.’
 
‘As the use of GLP-1 therapies increase, researchers are finding an increasing number of effects outside of weight loss,’ they wrote.
 
Chair of RACGP Specific Interests Respiratory Medicine, Dr Kerry Hancock, said it is ‘not surprising’ that GLP-1RAs have become a potential therapy for asthma.
 
‘With the high prevalence of co-existing asthma and obesity and with the lungs known to have a relatively high number of GLP-1 receptors, it is not surprising that the GLP-1 RAs, with their known anti-inflammatory and anti-obesity properties, have become a potential novel asthma therapy of interest,’ she told newsGP.
  
‘This large cohort study contributes to the growing body of evidence for the possible role of these therapeutic agents in improving outcomes for people with asthma, whether it be due to weight loss itself or the agents' anti-inflammatory effects or possibly a combination of both.’
 
Dr Hancock said current Australian and international guidelines recognise the ‘complex and bidirectional’ relationship between asthma and obesity, in that each condition can increase the risk of the other.
 
‘Obesity is a common comorbidity. Weight loss is known to improve asthma outcomes,’ she said.
 
However, Dr Hancock said prospective trials are still needed to clarify which specific population of people with asthma and obesity will have the best benefit for the cost of the medication.
 
She also believes GPs remain the ‘experts’ in caring for patients with asthma.
 
‘GPs and their teams remain the most appropriate health care professionals to provide this holistic and personalised care to people with asthma,’ she said.
 
‘GPs are the experts … it is important for them to continue to assess people with asthma within the three domains of pulmonary, extrapulmonary, and behavioural/lifestyle/risk factor traits, and applying targeted treatments to effectively manage these traits.’
 
Semaglutide may also have potential in managing migraine in women, according to another Danish study released at the obesity summit.
 
In the study, also funded by Novo Nordisk, researchers from the University of Southern Denmark suggest a link between GLP-1RAs and a reduction in use of triptan-class medications by women who experience migraine.
 
For that study, researchers examined the data of almost 150,000 people who had begun using semaglutide for weight loss treatment, of which 4.6% were also taking triptans – the first-line medication for prevention of migraine and cluster headaches – in the year before and after the study.
 
After a year of using semaglutide, researchers noted a 7% reduction in the use of triptans in women, but not in men. 
 
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