My Alzheimer's Journey
Part 47 - News From Novo Nordisk About Semaglutide Trials
The 18th Clinical Trials on Alzheimer’s Disease Conference (CTAD) is being held this week in San Diego. This event brings together Alzheimer researchers from around the world. There are roundtables and symposia that explore the latest advancements in AD research. The idea is to provide a platform for clinical research-focused dialogue and collaboration. Put another way, CTAD is a who’s who gathering of AD researchers.
(Maybe, I will start a fund soon to raise money for me to attend the next CTAD. Just imagine, “reporting live from CTAD are Greg & Big Bit”)
Peter Johannsen, Novo Nordisk’s international medical vice president, said in an address at the CTAD meeting that their semaglutide trials failed to show statistically significant slowing of cognitive decline in AD patients given the drug. He went on to say, “we still think it was the right decision... a scientific question that needed an answer,”
Let’s take a step back and talk about why Novo Nordisk was conducting clinical trails of semaglutide on AD patients.
Semaglutide is a leading GLP-1 medication used to manage type 2 diabetes and support long-term weight management. It is available under the brand names Ozempic, Wegovy, and Rybelsus, each with specific FDA-approved use. Since 2020, Novo Nordisk has been conducting clinical trials of its GLP-1 drug semaglutide on Alzheimer’s patients.
During early studies for semaglutide, when it was first approved for blood-sugar control, some cognitive benefits for diabetes patients were discovered. These cognitive gains showed up after about a year of treatment, and built with longer-term use. Additional research and animal testing showed that the GLP-1 hormone is involved in neurotransmission, with multiple effects across the brain.
During this same period, researchers in the United Kingdom were studying liraglutide, another GLP-1 drug manufactured by Novo Nardisk, for its possible use in treating Alzheimer’s. These studies showed promise that liraglutide may slow brain shrinkage and cognitive decline in people with mild Alzheimer’s.
In a 2024 trial, which Novo Nordisk partly funded, Imperial College London researchers followed more than 200 patients in the U.K. who had mild to moderate Alzheimer’s disease. Participants received either a daily injection of liraglutide or a placebo. Patients who received liraglutide had an 18% slower decline in cognitive function after one year of treatment compared to those who received the placebo.
A second phase of the Imperial College trial showed people who took liraglutide had almost 50% less brain volume loss in critical regions than those on placebo. The frontal, temporal, and parietal lobes, as well as the total gray matter, showed clear protection.
While these results are promising, even exciting, the Imperial trial was too small (both in the number of participants and in the length) to offer significant insight. This is where the much larger Novo Nordisk trials came into the picture.
Scientists believe GLP-1 class of drugs reduce inflammation, which often rises in AD and harms brain cells. It may also lower insulin resistance in the brain, improving how cells use energy. In addition, the drug seems to reduce the toxic effects of amyloid and tau proteins, which form plaques and tangles that characterize Alzheimer’s. By supporting healthier signalling between nerve cells and reducing damage, the drug may slow the chain of events that leads to brain shrinkage.
As an Alzheimer’s patient, these findings are exciting. At the same time, I understand the failure of the Novo Nordisk GLP-1 trail is a big setback. I am cautiously optimistic that GLP-1 will eventually result in a treatment that is more effective and easier to administer than Lecanemab and Donanemab.