The Expansion of GLP-1 Medications

Beyond Diabetes and Obesity: The Expansion of GLP-1 Medications

Glucagon-like peptide-1 (GLP-1) medications have revolutionized the treatment of diabetes and obesity, but their impact is rapidly broadening. Recent research and regulatory approvals reveal that GLP-1s may offer hope for a range of other health conditions, some of which might surprise you.

Metabolic dysfunction-associated steatohepatitis (MASH)

In August 2025, the Food and Drug Administration (FDA) approved Wegovy® (semaglutide) to treat adults with MASH with moderate to advanced liver scarring (fibrosis) without cirrhosis of the liver. About one in 20 people in the U.S. are affected by MASH, which is strongly linked to obesity, overweight, and Type 2 diabetes. This is the third FDA-approved indication for Wegovy and the first that does not require a diagnosis of obesity.

Sleep apnea

In December 2024, the FDA approved Zepbound® (tirzepatide) to treat severe obstructive sleep apnea (OSA) in adults with obesity. Zepbound became the first drug treatment for the illness. About 2% to 4% of the population has OSA, which is more common among people who are considered overweight or obese.

Substance use disorders (SUDs)

A recent study showed that heavy drinkers who took a GLP-1 cut their alcohol intake by about 70% and no one increased their alcohol intake.

There is preclinical evidence that GLP-1s help to reduce alcohol intake, reduce motivation to drink, and prevent drinking relapses by possibly lowering the alcohol-induced reward. Certain brain regions in the central nervous system are connected to the development of SUDs. Some preclinical studies have shown that dopamine signaling can be modulated, which reduces drug seeking and drug intake. Metabolic and neuroendocrine pathways are indirectly affected, causing a change in behavior. Currently, an estimated 10.2% of the U.S. population has alcohol use disorder (AUD).

Another study showed that people with AUD who took a GLP-1 had a 50% lower rate of alcohol intoxication than those who didn’t take one. The same study showed that people with opioid use disorder (OUD) who took a GLP-1 had a 40% lower rate of overdose as compared to those who didn’t take a GLP-1. Almost 4% of Americans need OUD treatment, according to the Centers for Disease Control and Prevention. A 2019 study showed that rats who were given a GLP-1 lowered their self-administration of oxycodone and their oxycodone-seeking behavior.

Mental health

Emerging research suggests GLP-1 medications may offer benefits beyond metabolic health, extending to mental health as well. Preclinical studies indicate that GLP-1s can exert antidepressant and anti-anxiety effects, with a recent systematic review noting that people who took GLP-1s had lower depression scores compared to those on placebo. These medications appear to reduce neuroinflammation and oxidative stress—two factors implicated in the development of depression and anxiety. Additionally, GLP-1s may promote neurogenesis and help regulate neurotransmitter systems, potentially alleviating symptoms of depression. In the United States, approximately 8.3% of the population experiences depression.

Cognitive health and Alzheimer’s disease

Ongoing research is also exploring the potential of GLP-1s to support cognitive health. An October 2024 study published in Alzheimer’s & Dementia reported that people with Type 2 diabetes who took semaglutide had a lower risk of being diagnosed with Alzheimer’s disease compared to those using other types of diabetes medications. Semaglutide is thought to have anti-inflammatory and neuroprotective properties and may help clear amyloid-beta, a major component of the plaque characteristic of Alzheimer’s pathology.

Currently, about 7 million people in the U.S. are living with Alzheimer’s disease. That number is expected to go up to around 13 million by 2050. The healthcare and societal costs of Alzheimer’s disease are significant. In 2025, health and long-term care costs for those with dementia are expected to reach $384 billion. By 2050, that number is estimated to reach about $1 trillion. Additionally, the caregiving burden is large—in 2024, unpaid caregivers supplied more than 19 billion care hours, and that care was valued at more than $413 billion.

Major Adverse Cardiovascular Event (MACE) reduction

Tirzepatide is being studied to treat MACE reduction in adults with type 2 diabetes. Semaglutide was approved for the indication in 2024. A recent modeling study showed that almost 2 million major cardiac events could be avoided if eligible patients took semaglutide at the requisite dose.

Heart failure with preserved ejection fraction (HFpEF)

Semaglutide is being looked at for adults with obesity who have HFpEF, a condition that occurs when the heart muscle can’t pump adequate blood to meet a person’s nutrition and oxygen needs. Today, HFpEF affects about 3 million Americans and nearly 32 million people globally.

Looking ahead to 2026

Next year, there will likely be approvals of new medicines and existing medicines in new strengths and dosages for existing indications such as weight loss and type 2 diabetes. These medicines will be in both injection and pill form.

Chronic Weight Management (CWM)

A higher dose of Wegovy is expected to be approved for CWM in late 2026.

Oral orforglipron from Eli Lilly & Company could be approved late next year or later.

Type 2 diabetes

New oral orforglipron could be approved for type 2 diabetes in late 2026.

A high dose of oral semaglutide could also be approved late next year.

MACE reduction

Tirzepatide injections for MACE reduction for people with type 2 diabetes may be approved in 2026.

Alzheimer’s disease

Oral semaglutide from Novo Nordisk could be approved to treat Alzheimer’s in late 2026 or later.

The field of GLP-1s is rapidly evolving with ongoing research uncovering more and more uses for the drug besides weight management and diabetes. The next few years could see major advancement, making GLP-1s one of the most interesting drugs to watch.

Want to stay up to date with the rapidly evolving GLP-1 market?

Gateway Health Partners’ clinical experts can help you develop and navigate strategies that balance cost management with patient access as indications continue to expand. Email Scott Webb to learn more or request a free savings analysis at [email protected]

References

• Wegovy® approved by FDA for the treatment of adults with noncirrhotic MASH with moderate to advanced liver fibrosis. Novo Nordisk. August 15, 2025.
• Kansteiner, Fraiser. Novo’s Wegovy picks up 3rd indication with key FDA approval in the liver disease MASH. Fierce Pharma. August 18, 2025.
• FDA Approves First Medication for Obstructive Sleep Apnea. Food & Drug Administration. December 20, 2024.
• Lovelace Jr., Berkeley. FDA approves weight loss drug Zepbound for sleep apnea. NBC News. December 20, 2024.
• Jacova Feld, Jayne. How GLP-1s Could Help People Sleep Better — Beyond Weight Loss. Endocrinology Advisor. April 25, 2025.
• Gunturu, Sasidhar. The Potential Role of GLP-1 Agonists in Psychiatric Disorders: A Paradigm Shift in Mental Health Treatment. Indian Journal of Psychological Medicine. April 12, 2024.
• Bruns VI, Nicolaus, Tressler, Elizabeth H., Vendruscolo, Leandro F., Leggio, Lorenzo, and Farokhnia, Mehdi. IUPHAR review – Glucagon-like peptide-1 (GLP-1) and substance use disorders: An emerging pharmacotherapeutic target. Pharmacological Research. Vol. 207. September 2024.
• Jerlhag, Elisabet. GLP-1 Receptor Agonists: Promising Therapeutic Targets for Alcohol Use Disorder. Endocrinology. Vol. 166, Issue 4. April 2025.
• Alcohol Use Disorder (AUD) in the United States: Age Groups and Demographic Characteristics. National Institutes of Health. National Institute on Alcohol Abuse and Alcoholism. September 2024.
• Malesu, Vijay Kumar. Are GLP-1 Drugs the Future of Alcohol Addiction Treatment? News-Medical.Net. March 5, 2025.
• Conley, Mark. Five things to know about GLP-1s and addiction. Stanford University School of Medicine. April 1, 2025.
• Dowell, Deborah, Brown, Samantha, Gyawali, Shiromani, Hoenig, Jennifer et al. Treatment for Opioid Use Disorder: Population Estimates — United States, 2022. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. June 27, 2024.
• Pakanati, Keerthana. Weight-loss meds may give people more control over drinking, study shows. ABC News. May 9, 2025.
• Zhang, Yafang, Kahng, Michelle W., Elkind, Jaclynn A., Weir, Vanessa R., Hernanez, Nicole S., Stein, Lauren M., and Schmidt, Heath D. Activation of GLP-1 receptors attenuates oxycodone taking and seeking without compromising the antinociceptive effects of oxycodone in rats. Neuropsychopharmacology. October 3, 2019.
• Herpen, Robert. Addiction, depression, cognition: How GLP-1s may benefit the brain, Healio. February 12, 2025.
• Major Depression. National Institutes of Health. National Institute of Mental Health. July 2023.
• Schimelpfening, Nancy. Ozempic Linked to Lower Alzheimer’s Risk in People with Type 2 Diabetes. Healthline. October 25, 2024.
• Alzheimer’s Disease Facts and Figures. Alzheimer’s Association.
• Oral Semaglutide Significantly Improves Cardiovascular Outcomes in Individuals with Type 2 Diabetes. American Diabetes Association. June 22, 2025.
• Kordella, Robert. GLP-1 Indications continue to expand: Potential approvals expected through 2026. Lockton. August 26, 2025.
• Semaglutide Use Could Prevent Up to 2 Million MACE in 10 Years, Model Suggests. American Journal of Managed Care. April 9, 2025.
• Heart Failure with Preserved Ejection Fraction (HFpEF). University of Michigan Health. Frankel Cardiovascular Center.
• FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight. Food and Drug Administration. March 8, 2024.