ESPE Abstracts

Background: Pituitary insufficiency and severe obesity are common sequelae of craniopharyngioma and its treatment. Once weekly glucagon-like Peptide 1 (GLP1) analog’s semaglutide has recently shown efficacy in adults with common obesity.

Objective: We evaluated the efficacy and safety of Semaglutide, a once-weekly GLP-1 analog, in 6 children with craniopharyngioma and morbid obesity.

Subjects and methods: This retrospective study included 6 children, (1 girl, 5 boys) followed at Angers University Hospital, with a history of craniopharyngioma. All suffered from severe obesity (BMI Z-score > 3 or rapid increase in BMI despite appropriate hormone replacement and lifestyle intervention). Children received subcutaneous semaglutide once a week, with a starting dose of 0.25mg/week, monthly increased to 0,5 mg then 1 mg/week, maintained at 1 mg/week for 6 months, and then increased to the maximally tolerated dose (not exceeding 2 mg). The parents and children received oral information regarding what is known about GLP-1 analogs and Semaglutide in obesity treatment, the main undesirable effects, the uncertainty about the efficacy and safety in craniopharyngioma, the out of marketing authorization of semaglutide in childhood obesity. Semaglutide treatment was indicated in the ALD protocol of the national health insurance, and cranial MRI were performed every 3 months at the onset of the treatment. All parents and children agreed to the treatment.

Results: Mean age was 15 ± 3.1 years, time from craniopharyngioma diagnosis was 7.9 ± 5.4 years, mean BMI was 2.47 ± 0.38 Z score, and mean weight increase the previous year was 15.7 ± 7.3 kg. Five subjects received rhGH, 6 levothyroxin, 6 hydrocortisone, 5 sex steroid or recombinant hCG and recombinant FSH, and 6 DDAVP. After a mean duration of semaglutide of 7.3 ± 5.8 months, a mean last dose of 1.1 ± 0.2 mg/week, the mean excess weight loss (EWL) was 28 ± 28 % (0-70%). Three children had moderate adverse events such as belching, abdominal pain, and diarrheas and 1 participant had a suicidal attempt.

Conclusion: Semaglutide treatment showed encouraging results regarding the loss of weight in children with craniopharyngioma induced obesity. Further randomized studies are necessary, but preliminary results are usually necessary before performing such large studies.