Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine.North America Syndicate
DEAR DR. ROACH: Please give me your opinion on the drug Rybelsus. It is advertised on TV as a wonder drug to reduce the A1C count for diabetics. My last A1C level was 6.8. My only problem with taking Rybelsus is that, in the package insert (or medication guide), it reads “not recommended as the first choice of medicine for treating diabetes.” Then it says in studies with rodents, it caused (not may cause) thyroid tumors including thyroid cancer, but it is not known if Rybelsus will cause thyroid tumors or thyroid cancer in people. This makes me feel like I am a test animal to justify that it is OK for people to take Rybelsus.
Why do you think the FDA would approve this questionable drug from a safe standpoint? — G.L.
ANSWER: Semaglutide (Rybelsus, Ozempic and Wegovy) is a newer medication for Type 2 diabetes that is also being used as a weight loss medication. While it is not the best first choice for most people, the safety and efficacy data are promising. It is effective at lowering blood sugar and improves the risk of heart disease and overall mortality, so semaglutide and similar medicines are being more frequently used. Most people with Type 2 diabetes and an A1C of 6.8% do not need additional medication.
The issue with thyroid cancer is not clear, but large studies done so far with this class of drugs in primate animals and in humans have shown no increase in the risk of thyroid cancer. People with a history of a particular type of thyroid cancer (medullary) or multiple endocrine neoplasia type 2 syndrome should not take this class of medicine.
The FDA always tries to balance risks and benefits. New medicines that show promise are often approved on the condition that the risks are both communicated to patients (like the “black box” warning you saw) and studied after the drug is marketed.
DEAR DR. ROACH: I am a 79-year-old physician who had a positive tuberculosis test during medical school in the late ‘60s. A chest X-ray showed some mild scarring. No treatment was instituted, and I had no problems until I developed temporal arteritis in 2006, requiring a year of oral prednisone, which resolved my problem.
Because of the positive tuberculin skin test, I was started on two anti-tuberculin medications, which I took for approximately nine months without difficulty.
My question is, if I had a T-SPOT blood test now, would it still be positive? If so, is there any way to tell if I have latent tuberculosis at this time, or is this just the T cells still reacting to the tuberculosis protein? Is there any way to know if I have latent TB? — H.D.
ANSWER: Latent tuberculosis is when a person has been infected by tuberculosis bacteria, but the body is keeping the infection from becoming active. Most people (especially those with an immune system problem) are recommended to have treatment, like the medications you received, to reduce the lifetime risk of developing active TB.
Unfortunately, both the skin test and the interferon tests tike the T-SPOT or QuantiFERON-TB Gold are usually positive even after prolonged treatment. There is no way to know whether every tuberculosis bacteria has been killed. Since you still have some risk, you should alert your doctor promptly with symptoms of tuberculosis, such as weight loss, fever, night sweats and cough. Fortunately, your lifetime risk for developing active tuberculosis is only about 1% after treatment, and after 50 years, your risk is now very small.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Jan 30, 2023