GLP-1 Use Remains Rare Among Eligible Patients With Multiple Sclerosis

Only a small percentage of patients with multiple sclerosis (MS) who are eligible for glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide (Ozempic, Wegovy, Rybelsus; Novo Nordisk) and tirzepatide (Mounjaro and Zepbound; Eli Lilly), have actually used them, according to a study published in the Multiple Sclerosis Journal.

GLP-1 RAs are increasingly being used to manage weight and cardiometabolic risk, yet uptake of these medications among people with MS has not been well characterized, which is notable since cardiometabolic comorbidities are known to be associated with adverse clinical outcomes in people with MS.²

“GLP1RAs have benefits on obesity and cardiovascular disease which is important as these conditions have been associated with adverse outcomes in [people with MS], suggesting there could be secondary benefits on MS,” the authors wrote.¹

Eligible Patients Aren't Getting GLP-1RA Therapy

Researchers conducted a cross-sectional survey of the NARCOMS Registry in fall 2024, collecting data on medication use, demographics, health behaviors, disability status, and comorbidities. Of the 6582 people invited to participate, 4181 met eligibility criteria. Multivariable logistic regression was used to identify factors associated with GLP-1 RA use among respondents. The findings showed 40.4% of participants met FDA-approved indications for GLP-1 RA use, but only 14.6% of those eligible had ever used one. Overall, just 7.4% of people with MS had ever used a GLP-1 RA, compared with about 12% of US adults generally.

"We observed a gap in this cross-sectional study; however, we do not fully understand the reasons for the gap," Ruth Ann Marrie, MD, PhD, professor in the departments of medicine and community health and epidemiology and the first Gillian’s Hope Multiple Sclerosis Clinical Research Chair at Dalhousie University in Halifax, Nova Scotia, Canada, and a co-author of the study, wrote in an email interview with The American Journal of Managed Care^®.

She pointed to various potential contributing factors such as a lack of insurance or financial resources, the therapy being offered but declined, the therapy not being offered due to competing demands or fragmented care, and existing polypharmacy.

"Hopefully, higher awareness of [cardiometabolic] impacts would increase consideration of possible interventions to target cardiometabolic comorbidities such as obesity, ideally through coordination of care between neurology and primary care," Marrie said.

Equity Concerns in GLP-1 RA Access

Patients who had used GLP-1 RAs were younger, had a shorter duration of MS, were more likely to have relapsing-remitting MS, were more likely to identify as Black, and had higher employment rates compared with those who had never used the drugs.

“The findings do raise concerns about inequitable access to these medications," Marrie noted.

However, GLP-1 RA users also carried a significantly greater cardiometabolic burden: 45.6% had diabetes versus 6.5% of nonusers, 57.8% were obese versus 24%, and 30.3% had 3 or more cardiometabolic comorbidities versus 7.7%. No significant difference in disability was observed between users and nonusers, assessed through the Patient-Determined Disease Steps scale. A separately cited single-center retrospective study similarly found no change in disability despite an average body mass index reduction of 3.7% among people with MS taking these medications. Gastrointestinal side effects were identified as the primary safety concern, as bowel dysfunction is already a frequent, early symptom in people with MS.

MS Cross-Sectional Study Limitations

This analysis is limited by its cross-sectional, self-report design, which restricts the ability to draw causal conclusions. The registry-based sample may also not generalize to younger populations with MS. The study captured only 2 commonly prescribed GLP-1 RAs as of 2024, without detailed data on treatment duration, adherence, or side effects, and it could not assess the effect of GLP-1 RA use on MS disease progression. Despite substantial eligibility, GLP-1 RA use remains low among people with MS, and the reasons behind this gap are not yet well understood.

"We need to understand why these therapies are or are not offered to people with indications, perspectives of people with MS about these medications, as well as the potential risks and benefits specific to MS," Marrie concluded.

References

1. Salter A, Novak A, Lancia S, Cutter GR, Fox RJ, Marrie RA. Use of semaglutide and tirzepatide among people with multiple sclerosis. Mult Scler. Published online April 29, 2026. doi:10.1177/13524585261442033

2. Rodriguez A. Cardiovascular conditions common in both patients with demyelinating diseases and unaffected individuals, study finds. AJMC. August 10, 2018. Accessed August 14, 2026. https://www.ajmc.com/view/cardiovascular-conditions-common-in-both-patients-with-demyelinating-diseases-and-unaffected-individuals-study-finds