Novo Nordisk presents semaglutide analyses on sleep apnea, asthma and liver health
Novo Nordisk's new semaglutide analyses point to possible benefits beyond weight and heart risk, but the data are post hoc and the drug is not approved for those conditions.
Novo Nordisk presented post hoc analyses from four semaglutide trials at the American Diabetes Association's 2026 Scientific Sessions, held June 5 through 8 in New Orleans [1][2]. The analyses cover obstructive sleep apnea, asthma-related outcomes, blood pressure, liver health and other weight-related conditions. Novo described them as exploratory and hypothesis-generating, and said semaglutide is not approved to treat obstructive sleep apnea, asthma, hypertension or MASLD [1].
In one post hoc analysis of the SELECT trial, 2,550 participants, or 14.5%, reported having obstructive sleep apnea at the start [1]. New cases were captured through adverse event reporting in people who did not have it at baseline, rather than through planned sleep testing. Among those participants, semaglutide injection 2.4 mg was associated with a lower incidence of obstructive sleep apnea than placebo (hazard ratio 0.48, 95% CI 0.31 to 0.74), with 30 cases in the semaglutide group and 65 in the placebo group, or 95 total [1]. The trial also found a reduced risk of major adverse cardiovascular events regardless of sleep apnea status (interaction p = 0.203) [1]. SELECT is the study that led to semaglutide's approved indication to reduce the risk of major adverse cardiovascular events in adults with obesity or overweight and established cardiovascular disease, along with diet and exercise [1].
A separate SELECT analysis followed 1,190 patients with self-reported asthma [1]. Those taking semaglutide 2.4 mg had fewer asthma-related adverse events or serious adverse events (27) than those on placebo (46), a hazard ratio of 0.58 (95% CI 0.36 to 0.93) [1]. The analysis also reported a 38.9% reduction in high-sensitivity C-reactive protein from baseline to week 104, with no changes in blood eosinophil or neutrophil counts [1].
On blood pressure, a pooled post hoc analysis included 597 adults with overweight or obesity and uncontrolled hypertension from the STEP 1, 3, 5-9 and OASIS 4 trials [1]. From baseline to week 68, semaglutide 2.4 mg was associated with an estimated treatment difference of –5.48 mmHg in systolic blood pressure (95% CI –7.78 to –3.19; p<0.0001) and –2.73 mmHg in diastolic blood pressure (95% CI –4.19 to –1.27; p=0.0003) compared with placebo [1].
Liver findings came from a post hoc analysis of part 1 of the ESSENCE trial, based on the first 800 randomized participants [1]. Novo said semaglutide 2.4 mg produced consistent improvements in cardiometabolic risk factors, including HbA1c, body weight, waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, non-HDL cholesterol and hsCRP, and in liver measures including ALT, controlled attenuation parameter, Enhanced Liver Fibrosis, FibroScan-AST and liver stiffness measurement through week 72, regardless of baseline blood sugar level, in people with MASH and liver fibrosis [1]. A separate post hoc analysis of STEP 1 reported lower fatty liver index scores from baseline to week 68 [1].
In the OASIS 4 trial, which enrolled 307 adults with obesity or overweight plus at least one weight-related condition and excluded people with diabetes, a post hoc analysis compared results by starting BMI [1]. Among those with class I overweight or obesity (BMI 27 to under 35, n=85), oral semaglutide 25 mg produced similar or greater improvements in cardiometabolic outcomes than in the class II/III group (BMI 35 or higher, n=119) at week 64 [1]. By week 64, 27% of the class I group had moved into the National Institute for Health and Care Excellence low health risk category based on waist-to-height ratio, compared with 2% of the class II/III group [1].
"These new analyses build on the growing body of clinical evidence for semaglutide," said Andrea Traina, Pharm.D., senior medical director for obesity and liver health at Novo Nordisk [1]. Domenica Rubino, MD, founder and director of the Washington Center for Weight Management & Research, said the analyses "add to our understanding of the critical ways semaglutide may impact those complications" [1].
Why it matters for patients
Post hoc analyses look back at data from trials designed to answer different questions, so they can show associations but cannot prove that semaglutide caused the improvements reported [1]. Novo states that further work on the clinical validity of these results would be of value, and that safety and efficacy for obstructive sleep apnea, asthma, hypertension and MASLD have not been established [1]. No new label claims or coverage decisions for those uses have been announced.
The numbers are still relevant to many patients, because these conditions often overlap with obesity and type 2 diabetes. About one in seven SELECT participants reported obstructive sleep apnea at the start of that trial [1], which enrolled 17,604 adults with established cardiovascular disease and no prior diabetes across 41 countries and more than 800 sites [1]. The asthma analysis is much smaller, at 1,190 patients [1].
The blood pressure analysis used a pooled group of 597 people with uncontrolled hypertension, so it covers a subset of the STEP and OASIS programs rather than a single trial [1]. The liver data come from part 1 of ESSENCE, a trial that planned to randomize 1,197 participants and test liver histology at 72 weeks [1].
Semaglutide injection 2.4 mg and semaglutide tablets 25 mg carry a boxed warning for possible thyroid tumors, including cancer, and should not be used in people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, according to the information Novo cited [1]. The most common side effects listed include nausea, diarrhea, vomiting, constipation, stomach pain, changes in skin sensations, headache, fatigue and hair loss, among others [1].
What happens next
The ADA sessions run through June 8, 2026, and the OASIS 4 analysis by BMI class was scheduled as a poster presentation on June 6 [2]. ESSENCE part 2 is ongoing; its main goal is to test whether semaglutide 2.4 mg lowers the risk of liver-related clinical events at 240 weeks [1]. Novo has not disclosed whether it will seek new approvals for obstructive sleep apnea, asthma, hypertension or MASLD based on these analyses [1].
Sources
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