Semaglutide treatment for obesity linked to Wernicke's Encephalopathy in six reported cases

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as semaglutide, are highly effective for obesity management due to their ability to suppress appetite and delay gastric emptying. While generally safe, these mechanisms can lead to persistent gastrointestinal adverse effects and substantial weight loss, potentially increasing the risk of nutritional deficiencies. One such critical deficiency is thiamine deficiency, which can precipitate Wernicke's encephalopathy (WE), a rare but severe neurological disorder that can cause irreversible cognitive impairment or death if not promptly recognized and treated.

Researchers conducted a systematic literature review using PRISMA guidelines across PubMed, Embase, CINAHL, and Scopus to identify case reports of Wernicke's encephalopathy associated with semaglutide use for obesity. Inclusion criteria required semaglutide to be prescribed for obesity and the patient's presentation to be consistent with Wernicke's encephalopathy. The study aimed to assess the drug safety profile from an endocrinological perspective, focusing on the clinical course and outcomes of identified cases.

The systematic review identified six distinct cases of Wernicke's encephalopathy occurring after semaglutide treatment for obesity. All six patients experienced prolonged gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, which led to substantial weight loss prior to the onset of neurological deterioration. Common neurological manifestations across these cases included altered mental status, ranging from confusion to coma, and various oculomotor abnormalities like nystagmus or ophthalmoplegia. The outcomes for several patients were notably poor, with some progressing to Korsakoff syndrome, a chronic and debilitating form of amnesia, or even resulting in death. This highlights a critical, albeit rare, adverse event associated with GLP-1RA therapy.

The review identified six cases where semaglutide use for obesity preceded Wernicke's encephalopathy, with all patients experiencing prolonged GI symptoms and significant weight loss.