Most People With MS Who Qualify for GLP-1 Drugs Are Not Taking Them, NARCOMS Survey Finds

According to a cross-sectional survey published in the Multiple Sclerosis Journal, only about 1 in 14 people with multiple sclerosis (MS) reported ever using glucagon-like peptide-1 receptor agonists (GLP-1 RAs), even though nearly 40% met the FDA-approved criteria for these medications.¹ All told, the findings reveal a substantial treatment gap at the intersection of MS and cardiometabolic disease, a comorbidity combination with growing evidence of adverse synergy.

Led by Amber Salter, PhD, MPH, the Kenney Marie Dixon-Pickens Distinguished Professor in Multiple Sclerosis Research at UT Southwestern Medical Center in Dallas and a specialist in MS biostatistics and clinical informatics, the study surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry in fall 2024. Of 6582 invited participants, 4697 (71.4%) responded, and 4181 met eligibility criteria for the analysis.

Overall, 301 participants (7.4%) had ever used semaglutide or tirzepatide, and 222 (5.5%) were current users. Of the 3765 never-users, 37.3% met the FDA-approved indication for GLP-1 RA use, defined as a BMI of 30 or greater, or a BMI of 27 or greater with at least 1 cardiometabolic condition or sleep apnea. Across the full cohort, 40.4% met the indication criteria; of those, only 14.6% had ever taken either drug.¹

Ever-users were younger (mean age, 62.6 vs 64.7 years; P < .01), more likely to identify as Black (4.7% vs 1.9%; P < .01), more likely to have a relapsing disease course (66.2% vs 54.7%; P < .01), and more likely to be employed (64.5% vs 75.4%; P < .01) than never-users; they also had substantially higher rates of obesity (57.8% vs 24.0%, respectively) and diabetes (45.6% vs 6.5%).¹ Mean BMI was 32.8 in ever-users vs 27.3 in never-users (P < .01).

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Among those who met the indication for GLP-1 RA use, multivariable logistic regression identified older age as associated with lower odds of ever using these medications (OR, 0.66; 95% CI, 0.57-0.77), whereas a higher number of cardiometabolic comorbidities was strongly associated with elevated odds of use. Compared with those with no cardiometabolic conditions, those with 2 conditions had 2.1 times higher odds of use (95% CI, 1.26-3.34), and those with 3 or more had 5.6 times higher odds (95% CI, 3.48-9.12). Disease burden, as measured by the Patient-Determined Disease Steps scale, was not significantly associated with GLP-1 RA use.

The findings arrive as interest in GLP-1 RAs in MS has grown, driven by evidence that obesity and cardiometabolic comorbidities are associated with worse MS outcomes. A 2024 study by Salter et al in JAMA Neurology found that comorbidity burden was independently associated with MS disease activity, underscoring the potential relevance of metabolic management in this population.² A 2025 randomized controlled trial published in the Journal of Neurology, Neurosurgery & Psychiatry found that intermittent caloric restriction improved cognition and produced beneficial metabolic and immunological changes in people with MS, raising the question of whether GLP-1 RAs might replicate or extend those benefits through weight-independent mechanisms.³

Several limitations applied to the most recently published study. Among them is that the NARCOMS Registry is self-report and voluntary, introducing potential response and selection biases. Nonresponders were more likely to be Black, have less education, and have more disability, suggesting the analysis may underestimate GLP-1 RA use in more disabled or socioeconomically disadvantaged MS populations. Furthermore, the study captured only semaglutide and tirzepatide and did not assess other GLP-1 RAs, duration of use, adherence, or reasons for nonuse.

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 J. Published online April 29, 2026. doi:10.1177/13524585261442033
2. Salter A, Lancia S, Kowalec K, Fitzgerald KC, Marrie RA. Comorbidity and disease activity in multiple sclerosis. JAMA Neurol. 2024;81(11):1170-1177. doi:10.1001/jamaneurol.2024.2920
3. Ghezzi L, Tosti V, Shi L, et al. Randomised controlled trial of intermittent calorie restriction in people with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2025;96(2):158-169. doi:10.1136/jnnp-2024-333465