Glucagon-like peptide-1 receptor agonists in combination therapy of gonarthrosis in patients with metabolic syndrome: Results of a 24-week prospective randomized study
Abstract. Comorbidity of knee joint osteoarthritis (KJO) and metabolic syndrome requires therapy that combines symptomatic, slow-release medications with drugs that affect body weight and systemic inflammation.Surov A.I., Dzodzuashvili K.K., Shokhin A.A., Trofimov E.A., Trofimova A.S., Parinskaya Yu.R.
The aim: to estimate the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1a) in combination with diacerein in patients with KJO and metabolic syndrome during 24 weeks.
Material and methods. A prospective, randomized study included 117 patients aged 35–65 years with Kellgren – Lawrence stages I–III gonarthrosis and BMI ≥ 30 kg/m². Participants were randomized into four treatment groups: Group 1 received diacerein, Group 2 received diacerein + metformin, Group 3 received diacerein + semaglutide (titrated 0.25–0.5–1.0 mg/week), and Group 4 received diacerein + semaglutide (titrated to 2.4 mg/week). BMI, pain using WOMAC scale and visual analog scale (VAS), C-reactive protein (CRP) and interleukin 6 levels, and adverse therapy events were assessed.
Results. By week 12, in the groups of patients receiving semaglutide, body weight reduction was 4.0–4.1% with pain reduction according to WOMAC by 26.4–27.3% and according to VAS by 15.2–18.3%, whereas in the groups without the use of GLP-1 arginine, body weight reduction did not exceed 1.6%, and pain reduction according to WOMAC and VAS varied within 10.9–12.7% and 6.8–8.3%, respectively. By week 24, weight loss in the semaglutide groups reached 6.5–8.0%, with pain reduction of 34.5–40.0% according to WOMAC scale and 22.0–29.2% according to VAS scale. Comparatively to the semaglutide-free regimens, weight loss was limited to 2.5%, with pain reduction of 14.5–17.3% according to WOMAC scale and 8.7–10.0% according to VAS scale. Adverse events were more common in participants receiving semaglutide, primarily gastrointestinal side effects during the dose titration period.
Conclusion. The addition of semaglutide to diacerein in patients with KJO and metabolic syndrome is associated with a more pronounced reduction in pain, BMI, and inflammatory markers (CRP and IL-6) comparatively to regimens without GLP-1 agonists.
Keywords
gonarthrosis
obesity
semaglutide
diacerein
inflammation
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About the Authors
Anatoly I. Surov, MD, therapist, applicant at the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia; therapist at Saint Petersburg City Polyclinic No. 60, Pushkinsky district. Address: 191015, Saint Petersburg, 41 Kirochnaya St.E-mail: dr.surov.a.i@yandex.ru
ORCID: https://orcid.org/0009-0008-2908-0928
Karlo K. Dzodzuashvili, MD, PhD (Medicine), traumatologist-orthopedist, chief physician of Saint Petersburg City Polyclinic No. 60, Pushkinsky district. Address: 196607, Saint Petersburg, Pushkin, 15 Magazeynaya St.
E-mail: dzokar@gmail.com
Andrei A. Shokhin, MD, rheumatologist, applicant at the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: andra.11@yandex.ru
ORCID: https://orcid.org/0009-0000-5440-237X
Evgeniy A. Trofimov, MD, Dr. Sci. (Medicine), professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: Evgeniy.trofimov@szgmu.ru
ORCID: https://orcid.org/0000-0003-3236-4485
Anna S. Trofimova, MD, Dr. Sci. (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: Anna.Trofimova@szgmu.ru
ORCID: https://orcid.org/0000-0001-5926-7912
Yulia R. Parinskaya, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya St.
E-mail: ule8@yandex.ru
ORCID: https://orcid.org/0000-0001-8136-0697
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