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-1RAs), 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, the Kenney Marie Dixon-Pickens Distinguished Professor in Multiple Sclerosis Research at UT Southwestern Medical Center and a specialist in MS biostatistics and clinical informatics, the study surveyed participants in the 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-1RA use, defined as a BMI of 30 or greater, or a BMI of 27 or greater with at least one 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

Compared with never-users, 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), more likely to be employed (P < .01), and had substantially higher rates of obesity (57.8% vs 24.0%) and diabetes (45.6% vs 6.5%).¹ Mean BMI was 32.8 in ever-users versus 27.3 in never-users (P < .01).

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Among those who met the indication for GLP-1RA use, multivariable logistic regression identified older age as associated with lower odds of ever using these medications (OR 0.66; 95% CI, 0.57 to 0.77), while 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 (OR 2.1; 95% CI, 1.26 to 3.34), and those with 3 or more had 5.6 times higher odds (OR 5.6; 95% CI, 3.48 to 9.12). Disease burden, as measured by the Patient-Determined Disease Steps scale, was not significantly associated with GLP-1RA use.

The findings arrive as interest in GLP-1RAs in MS has grown, driven by evidence that obesity and cardiometabolic comorbidities are associated with worse MS outcomes. A 2024 study by Salter and colleagues 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-1RAs might replicate or extend those benefits through weight-independent mechanisms.³

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

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. https://doi.org/10.1177/13524585261442033
2. Salter A, Lancia S, Kowalec K, et al. Comorbidity and disease activity in multiple sclerosis. JAMA Neurol. 2024;81:1170-1177. doi:10.1001/jamaneurol.2024.2920. https://doi.org/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;96:158-169. doi:10.1136/jnnp-2024-333465. https://doi.org/10.1136/jnnp-2024-333465