EP854 - ECE_3854 - Off-label use of semaglutide (Ozempic®) for weight reduction: a real-world case series of 20 patients
Abstract
Obesity is a chronic metabolic condition closely linked to insulin resistance and increased cardiometabolic risk. While semaglutide 2.4 mg is specifically approved for obesity treatment, lower doses of semaglutide (Ozempic®) are frequently used off-label for weight reduction in everyday clinical practice. However, real-world data describing outcomes with these lower doses remain scarce. To evaluate weight loss outcomes and tolerability of off-label semaglutide (Ozempic®) in adults with overweight or obesity in a routine outpatient setting. This real-world case series included 20 adult patients (17 women and 3 men) with overweight or obesity, with a mean age of 42 years and a mean baseline BMI of 33 kg/m2. All patients were managed in an outpatient endocrinology clinic. Semaglutide (Ozempic®) was initiated at 0.25 mg once weekly and gradually titrated according to clinical response and tolerability; all patients reached a maximum dose of 1.0 mg weekly. The mean follow-up period was 6 months. Changes in body weight and BMI were assessed using routine clinical data. Adverse events and treatment discontinuations were systematically recorded. Off-label prescribing was based on clinical judgment and informed patient consent. After 6 months of treatment, patients experienced a mean weight reduction of 9.8% from baseline, accompanied by a consistent decrease in BMI across the cohort. Gastrointestinal adverse events—primarily nausea and reduced appetite—were reported by 8 patients (40%) and were mostly mild to moderate in severity. Treatment was discontinued in 2 patients due to intolerance. No serious adverse events were observed. In this real-world case series, off-label use of semaglutide (Ozempic®) at doses up to 1.0 mg weekly was associated with clinically meaningful weight loss over 6 months and an acceptable tolerability profile. These findings suggest that lower-dose semaglutide may be an effective option for weight reduction in routine clinical practice, while underscoring the need for larger prospective studies to better define long-term safety and efficacy.