DEAR DOCTOR. ROACH: Please tell me what you think about Rybelsus drug. It is advertised on TV as a miracle cure to lower A1C levels in diabetics. My last A1C was 6.8. My only issue with taking Rybelsus is that the package insert (or medication guide) says “Not recommended as a first-line treatment for diabetes”. Then, in rodent studies, it is said to cause (cannot cause) thyroid tumors including thyroid cancer, but it is not known whether Rybelsus will cause thyroid tumors or thyroid cancer in humans. This makes me feel like I’m a laboratory animal to justify that it’s okay for humans to take Rybelsus.
Why do you think the FDA would approve this questionable drug from a safe standpoint? –GL
ANSWER: Semaglutide (Rybelsus, Ozempic, and Wegovy) is a newer drug for type 2 diabetes that is also used as a weight loss drug. While it’s not the best first choice for most people, the safety and efficacy data is promising. It is effective in lowering blood sugar and improving the risk of heart disease and all-cause mortality, so semaglutide and similar drugs are becoming more widely used. Most people with type 2 diabetes and an A1C of 6.8% do not need any additional medication.
The problem with thyroid cancer is not clear, but large studies conducted to date with this class of drugs in primates and humans have shown no increase in the risk of thyroid cancer. People with a history of a specific type of thyroid cancer (medullary) or multiple endocrine neoplasia type 2 syndrome should not take this class of drugs.
The FDA always tries to balance risks and benefits. New promising drugs are often approved on condition that the risks are both communicated to patients (like the ‘black box’ warning you saw) and investigated after the drug has been launched.
DEAR DOCTOR. ROACH: I’m a 79-year-old doctor who tested positive for tuberculosis in the late ’60s while in medical school. A chest X-ray showed some light scars. No treatment was initiated and I had no problems until 2006, when I developed temporal arteritis that required oral prednisone for a year, which solved my problem.
Because of the positive tuberculin skin test, I was started on two anti-tuberculin medications, which I took for about nine months with no problem.
My question is if I had a T-SPOT blood test now would it still be positive? If so, is there any way I can tell at this point if I have latent tuberculosis, or is it just the T cells that are still responding to the tuberculosis protein? Is there a way to tell if I have latent tuberculosis? – HD
ANSWER: Latent tuberculosis is when a person has been infected with tuberculosis bacteria, but the body prevents the infection from becoming active. Most people (particularly those with an immune system problem) are advised to be treated like the medications they were given to reduce their lifetime risk of developing active TB.
Unfortunately, both the skin test and the interferon tests such as the T-SPOT or QuantiFERON-TB Gold are mostly positive even after longer treatment. Whether all tuberculosis bacteria have been killed cannot be determined. Because you are still at risk, if you have tuberculosis symptoms such as weight loss, fever, night sweats, and cough, you should notify your doctor immediately. Fortunately, your lifetime risk of developing active tuberculosis after treatment is only about 1%, and at 50 years your risk is now very low.
dr Roach regrets that he cannot reply to individual letters, but will include them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or mail them to 628 Virginia Dr., Orlando, FL 32803.
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