{"id":216,"date":"2020-01-07T04:47:05","date_gmt":"2020-01-07T04:47:05","guid":{"rendered":"http:\/\/lgmd1d.org\/lgmdwp\/?p=216"},"modified":"2025-12-08T18:11:59","modified_gmt":"2025-12-09T02:11:59","slug":"have-symptoms-try-symptomate","status":"publish","type":"post","link":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/","title":{"rendered":"LGMD and GLP-1 Drugs, 2025"},"content":{"rendered":"\r\n<h3 data-start=\"0\" data-end=\"406\"><strong>Short version:<\/strong><\/h3>\r\n<h3 data-start=\"0\" data-end=\"406\"><br data-start=\"14\" data-end=\"17\" \/>There\u2019s <strong data-start=\"25\" data-end=\"136\">no direct evidence that GLP-1 \/ GIP-GLP-1 drugs are inherently unsafe or absolutely contraindicated in LGMD<\/strong>, but there <em data-start=\"148\" data-end=\"153\">are<\/em> very reasonable concerns about <strong data-start=\"185\" data-end=\"228\">additional lean-muscle loss and frailty<\/strong> in someone who already has a primary myopathy. Any statement about \u201cGLP-1 drugs in LGMD\u201d is valid <strong data-start=\"327\" data-end=\"406\">only if it\u2019s framed as \u201chigh-caution, individualized use,\u201d not \u201cnever use.\u201d<\/strong><\/h3>\r\n<p data-start=\"408\" data-end=\"465\">\u00a0<\/p>\r\n<hr data-start=\"467\" data-end=\"470\" \/>\r\n<h2 data-start=\"472\" data-end=\"516\">1. What evidence actually exists in LGMD?<\/h2>\r\n<ul data-start=\"518\" data-end=\"958\">\r\n<li data-start=\"518\" data-end=\"763\">\r\n<p data-start=\"520\" data-end=\"763\">I\u2019m not finding <strong data-start=\"536\" data-end=\"624\">clinical trials or case series specifically testing GLP-1 RAs or tirzepatide in LGMD<\/strong>. Current LGMD drug headlines are about <strong data-start=\"664\" data-end=\"711\">gene therapies or other experimental agents<\/strong>, not GLP-1s.<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/synapse.patsnap.com\/blog\/viking-therapeutics-launches-phase-2-study-of-vk2735-for-obesity?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Synapse<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<li data-start=\"764\" data-end=\"958\">\r\n<p data-start=\"766\" data-end=\"958\">The recent safety scare you may have seen that mentions <strong data-start=\"822\" data-end=\"853\">LGMD and a patient fatality<\/strong> is about an <strong data-start=\"866\" data-end=\"895\">LGMD gene therapy program<\/strong>, not about GLP-1 drugs.<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.primetherapeutics.com\/trending-topics-drug-approvals-july-2025?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Prime Therapeutics<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"960\" data-end=\"1051\">So any statement about GLP-1s in LGMD is, by necessity, <strong data-start=\"1016\" data-end=\"1033\">extrapolation<\/strong>, not direct data.<\/p>\r\n<hr data-start=\"1053\" data-end=\"1056\" \/>\r\n<h2 data-start=\"1058\" data-end=\"1115\">2. What do we know about GLP-1 \/ GIP-GLP-1 and muscle?<\/h2>\r\n<h3 data-start=\"1117\" data-end=\"1164\">a) Lean mass loss is real, but proportional<\/h3>\r\n<p data-start=\"1166\" data-end=\"1215\">Across large semaglutide and tirzepatide studies:<\/p>\r\n<ul data-start=\"1217\" data-end=\"1691\">\r\n<li data-start=\"1217\" data-end=\"1429\">\r\n<p data-start=\"1219\" data-end=\"1429\">Typically <strong data-start=\"1229\" data-end=\"1272\">~25\u201335% of the weight lost is lean mass<\/strong>, the rest is fat. This pattern holds for tirzepatide and high-dose semaglutide (STEP, SURMOUNT and related analyses).<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/dom-pubs.onlinelibrary.wiley.com\/doi\/10.1111\/dom.15728?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Wiley Online Library<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<li data-start=\"1430\" data-end=\"1691\">\r\n<p data-start=\"1432\" data-end=\"1482\">Reviews of GLP-1 RAs and sarcopenia conclude that:<\/p>\r\n<ul data-start=\"1485\" data-end=\"1691\">\r\n<li data-start=\"1485\" data-end=\"1520\">\r\n<p data-start=\"1487\" data-end=\"1520\">They <strong data-start=\"1492\" data-end=\"1515\">do reduce lean mass<\/strong>, but<\/p>\r\n<\/li>\r\n<li data-start=\"1523\" data-end=\"1691\">\r\n<p data-start=\"1525\" data-end=\"1691\">The proportion of muscle lost is <strong data-start=\"1558\" data-end=\"1604\">similar to other weight-loss interventions<\/strong> (diet, bariatric surgery, intensive lifestyle).<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12325148\/?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">PMC<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"1693\" data-end=\"1819\">So: GLP-1s are <strong data-start=\"1708\" data-end=\"1744\">not uniquely \u201cmuscle-destroying\u201d<\/strong>, but they <strong data-start=\"1755\" data-end=\"1790\">can unmask or worsen sarcopenia<\/strong> in already fragile patients.<\/p>\r\n<h3 data-start=\"1821\" data-end=\"1857\">b) Neuromuscular disease context<\/h3>\r\n<ul data-start=\"1859\" data-end=\"2378\">\r\n<li data-start=\"1859\" data-end=\"2150\">\r\n<p data-start=\"1861\" data-end=\"2150\">The FSHD Society has already raised concerns about GLP-1 use in muscular dystrophies, describing a patient with substantial weight loss and subjectively worsened muscle function, and advising <strong data-start=\"2053\" data-end=\"2110\">very cautious use plus strength-preserving strategies<\/strong>.<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.fshdsociety.org\/2024\/08\/12\/muscle-loss-with-ozempic-and-similar-drugs\/?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">FSHD Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<li data-start=\"2151\" data-end=\"2378\">\r\n<p data-start=\"2153\" data-end=\"2378\">For LGMD, baseline <strong data-start=\"2172\" data-end=\"2249\">proximal weakness, respiratory vulnerability and sometimes cardiomyopathy<\/strong> mean <em data-start=\"2255\" data-end=\"2260\">any<\/em> extra loss of lean mass may have outsized functional consequences (falls, loss of transfers, reduced cough strength).<\/p>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"2380\" data-end=\"2533\">So, <strong data-start=\"2384\" data-end=\"2419\">from a neuromuscular standpoint<\/strong>, it\u2019s absolutely valid to treat GLP-1 \/ tirzepatide as <strong data-start=\"2475\" data-end=\"2532\">high-risk for deconditioning if not carefully managed<\/strong>.<\/p>\r\n<hr data-start=\"2535\" data-end=\"2538\" \/>\r\n<h2 data-start=\"2540\" data-end=\"2607\">3. Class adverse-effect profile (relevant but not LGMD-specific)<\/h2>\r\n<p data-start=\"2609\" data-end=\"2746\">Your uploaded comparison chart and eye-risk article nicely summarize the <strong data-start=\"2682\" data-end=\"2705\">class safety issues<\/strong>:<\/p>\r\n<ul data-start=\"2748\" data-end=\"3267\">\r\n<li data-start=\"2748\" data-end=\"2841\">\r\n<p data-start=\"2750\" data-end=\"2841\"><strong data-start=\"2750\" data-end=\"2765\">Very common<\/strong>: GI intolerance (nausea, vomiting, diarrhea), dehydration \u2192 possible AKI.<\/p>\r\n<\/li>\r\n<li data-start=\"2842\" data-end=\"3048\">\r\n<p data-start=\"2844\" data-end=\"3048\"><strong data-start=\"2844\" data-end=\"2856\">Warnings<\/strong>: gallbladder disease, pancreatitis (causality still debated), possible bowel obstruction \/ ileus, and medullary thyroid carcinoma\/MEN2 contraindication.<\/p>\r\n<\/li>\r\n<li data-start=\"3049\" data-end=\"3267\">\r\n<p data-start=\"3051\" data-end=\"3267\"><strong data-start=\"3051\" data-end=\"3061\">Ocular<\/strong>: retinopathy warnings already on labels; new observational signals for <strong data-start=\"3133\" data-end=\"3141\">nAMD<\/strong> and <strong data-start=\"3146\" data-end=\"3155\">NAION<\/strong> with semaglutide, but events are <em data-start=\"3189\" data-end=\"3200\">very rare<\/em> and data are observational.<\/p>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"3269\" data-end=\"3523\">None of these are <strong data-start=\"3287\" data-end=\"3299\">specific<\/strong> to LGMD, but in a patient with <strong data-start=\"3331\" data-end=\"3382\">limited mobility and possible swallowing issues<\/strong>, the consequences of severe vomiting, dehydration, or ileus can be more serious (falls, aspiration, hospitalizations, rapid deconditioning).<\/p>\r\n<hr data-start=\"3525\" data-end=\"3528\" \/>\r\n<h2 data-start=\"3530\" data-end=\"3595\">4. Is it valid to say GLP-1 drugs \u201cshouldn\u2019t be used\u201d in LGMD?<\/h2>\r\n<p data-start=\"3597\" data-end=\"3623\">Based on current evidence:<\/p>\r\n<h3 data-start=\"3625\" data-end=\"3665\">Statements that would <em data-start=\"3651\" data-end=\"3656\">not<\/em> be valid<\/h3>\r\n<ul data-start=\"3667\" data-end=\"4092\">\r\n<li data-start=\"3667\" data-end=\"3907\">\r\n<p data-start=\"3669\" data-end=\"3708\">\u201cGLP-1s are contraindicated in LGMD.\u201d<\/p>\r\n<ul data-start=\"3711\" data-end=\"3907\">\r\n<li data-start=\"3711\" data-end=\"3907\">\r\n<p data-start=\"3713\" data-end=\"3907\">There is <strong data-start=\"3722\" data-end=\"3769\">no regulatory or guideline contraindication<\/strong> specific to LGMD (ADA, AACE, neuromuscular guidelines do not list LGMD as a do-not-use condition).<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"3908\" data-end=\"4092\">\r\n<p data-start=\"3910\" data-end=\"3952\">\u201cGLP-1s directly damage muscle in LGMD.\u201d<\/p>\r\n<ul data-start=\"3955\" data-end=\"4092\">\r\n<li data-start=\"3955\" data-end=\"4092\">\r\n<p data-start=\"3957\" data-end=\"4092\">Human data show <strong data-start=\"3973\" data-end=\"4009\">proportional lean-mass reduction<\/strong>, not a dramatic, drug-specific myotoxicity.<span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12325148\/?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">PMC<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"4094\" data-end=\"4261\">So if \u201cGLP-1 Drugs in LGMD\u201d was being used to imply <strong data-start=\"4146\" data-end=\"4170\">absolute prohibition<\/strong> or <strong data-start=\"4174\" data-end=\"4216\">direct muscle toxicity in this disease<\/strong>, that would overstate what we actually know.<\/p>\r\n<h3 data-start=\"4263\" data-end=\"4315\">Statements that <em data-start=\"4283\" data-end=\"4288\">are<\/em> valid and evidence-aligned<\/h3>\r\n<ul data-start=\"4317\" data-end=\"4768\">\r\n<li data-start=\"4317\" data-end=\"4552\">\r\n<p data-start=\"4319\" data-end=\"4398\">\u201cIn LGMD, GLP-1 \/ tirzepatide should be considered <strong data-start=\"4370\" data-end=\"4386\">high-caution<\/strong> because of:<\/p>\r\n<ul data-start=\"4401\" data-end=\"4552\">\r\n<li data-start=\"4401\" data-end=\"4468\">\r\n<p data-start=\"4403\" data-end=\"4468\">predictable <strong data-start=\"4415\" data-end=\"4433\">lean-mass loss<\/strong> with rapid weight reduction, and<\/p>\r\n<\/li>\r\n<li data-start=\"4471\" data-end=\"4552\">\r\n<p data-start=\"4473\" data-end=\"4552\">the high functional cost of even modest extra strength loss in these patients.\u201d<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"4553\" data-end=\"4768\">\r\n<p data-start=\"4555\" data-end=\"4615\">\u201cUse is not automatically wrong, but should only occur with:<\/p>\r\n<ul data-start=\"4618\" data-end=\"4768\">\r\n<li data-start=\"4618\" data-end=\"4665\">\r\n<p data-start=\"4620\" data-end=\"4665\">clear metabolic\/cardiovascular indications,<\/p>\r\n<\/li>\r\n<li data-start=\"4668\" data-end=\"4732\">\r\n<p data-start=\"4670\" data-end=\"4732\">slow titration and <em data-start=\"4689\" data-end=\"4702\">intentional<\/em> muscle-preserving plan, and<\/p>\r\n<\/li>\r\n<li data-start=\"4735\" data-end=\"4768\">\r\n<p data-start=\"4737\" data-end=\"4768\">close neuromuscular follow-up.\u201d<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p data-start=\"4770\" data-end=\"4920\">That framing matches what we know about body-composition effects, sarcopenia risk, and general safety, even though we lack LGMD-specific outcome data.<\/p>\r\n<hr data-start=\"4922\" data-end=\"4925\" \/>\r\n<h2 data-start=\"4927\" data-end=\"4979\">5. Practical clinical approach in an LGMD patient<\/h2>\r\n<p data-start=\"4981\" data-end=\"5092\">If I were writing a more precise version of \u201cGLP-1 Drugs in LGMD\u201d for clinicians, it would look something like:<\/p>\r\n<blockquote data-start=\"5094\" data-end=\"5201\">\r\n<p data-start=\"5096\" data-end=\"5201\"><strong data-start=\"5096\" data-end=\"5112\">Assumptions:<\/strong> Adult with LGMD, obesity and\/or type 2 diabetes, relatively stable respiratory function.<\/p>\r\n<\/blockquote>\r\n<ol data-start=\"5203\" data-end=\"6656\">\r\n<li data-start=\"5203\" data-end=\"5462\">\r\n<p data-start=\"5206\" data-end=\"5228\"><strong data-start=\"5206\" data-end=\"5228\">Clarify indication<\/strong><\/p>\r\n<ul data-start=\"5232\" data-end=\"5462\">\r\n<li data-start=\"5232\" data-end=\"5462\">\r\n<p data-start=\"5234\" data-end=\"5462\">Only consider GLP-1 \/ tirzepatide if there is a <strong data-start=\"5282\" data-end=\"5320\">strong ADA\/AACE-aligned indication<\/strong> (T2D needing additional A1c reduction, obesity with cardiometabolic risk, CKD or CV risk reduction).<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"5464\" data-end=\"5763\">\r\n<p data-start=\"5467\" data-end=\"5491\"><strong data-start=\"5467\" data-end=\"5491\">Baseline assessments<\/strong><\/p>\r\n<ul data-start=\"5495\" data-end=\"5763\">\r\n<li data-start=\"5495\" data-end=\"5587\">\r\n<p data-start=\"5497\" data-end=\"5587\">Document <strong data-start=\"5506\" data-end=\"5527\">functional status<\/strong>: MRC scores, timed sit-to-stand, stair or transfer ability.<\/p>\r\n<\/li>\r\n<li data-start=\"5591\" data-end=\"5649\">\r\n<p data-start=\"5593\" data-end=\"5649\">Consider <strong data-start=\"5602\" data-end=\"5617\">DEXA or BIA<\/strong> to track lean mass if feasible.<\/p>\r\n<\/li>\r\n<li data-start=\"5653\" data-end=\"5763\">\r\n<p data-start=\"5655\" data-end=\"5763\">Obtain <strong data-start=\"5662\" data-end=\"5683\">baseline eye exam<\/strong> as suggested in your eye-risk article.<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"5765\" data-end=\"6009\">\r\n<p data-start=\"5768\" data-end=\"5795\"><strong data-start=\"5768\" data-end=\"5795\">Drug and dose selection<\/strong><\/p>\r\n<ul data-start=\"5799\" data-end=\"6009\">\r\n<li data-start=\"5799\" data-end=\"5864\">\r\n<p data-start=\"5801\" data-end=\"5864\">Prefer <strong data-start=\"5808\" data-end=\"5852\">lower starting dose and slower titration<\/strong> than usual.<\/p>\r\n<\/li>\r\n<li data-start=\"5868\" data-end=\"6009\">\r\n<p data-start=\"5870\" data-end=\"6009\">Avoid aggressive weight-loss targets; aim for <strong data-start=\"5916\" data-end=\"5940\">modest, gradual loss<\/strong> (e.g., 5\u20137% over 6\u201312 months) unless benefits clearly outweigh risk.<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"6011\" data-end=\"6353\">\r\n<p data-start=\"6014\" data-end=\"6044\"><strong data-start=\"6014\" data-end=\"6044\">Muscle-preserving strategy<\/strong><\/p>\r\n<ul data-start=\"6048\" data-end=\"6353\">\r\n<li data-start=\"6048\" data-end=\"6249\">\r\n<p data-start=\"6050\" data-end=\"6096\">Coordinate with neuromuscular and rehab teams:<\/p>\r\n<ul data-start=\"6102\" data-end=\"6249\">\r\n<li data-start=\"6102\" data-end=\"6171\">\r\n<p data-start=\"6104\" data-end=\"6171\"><strong data-start=\"6104\" data-end=\"6131\">Adequate protein intake<\/strong> (often \u22651.2 g\/kg\/day if kidneys allow).<\/p>\r\n<\/li>\r\n<li data-start=\"6177\" data-end=\"6249\">\r\n<p data-start=\"6179\" data-end=\"6249\">Tailored <strong data-start=\"6188\" data-end=\"6224\">resistance \/ functional training<\/strong> within LGMD limitations.<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"6253\" data-end=\"6353\">\r\n<p data-start=\"6255\" data-end=\"6353\">Reassess if the patient reports new falls, loss of transfers, or decline in FVC or cough strength.<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li data-start=\"6355\" data-end=\"6656\">\r\n<p data-start=\"6358\" data-end=\"6388\"><strong data-start=\"6358\" data-end=\"6388\">Stop \/ reassess thresholds<\/strong><\/p>\r\n<ul data-start=\"6392\" data-end=\"6656\">\r\n<li data-start=\"6392\" data-end=\"6473\">\r\n<p data-start=\"6394\" data-end=\"6473\">New or rapid <strong data-start=\"6407\" data-end=\"6429\">functional decline<\/strong> temporally associated with dose escalation.<\/p>\r\n<\/li>\r\n<li data-start=\"6477\" data-end=\"6545\">\r\n<p data-start=\"6479\" data-end=\"6545\">Intolerable GI effects \u2192 hospitalization or marked deconditioning.<\/p>\r\n<\/li>\r\n<li data-start=\"6549\" data-end=\"6656\">\r\n<p data-start=\"6551\" data-end=\"6656\">Significant or progressive ocular symptoms (NAION\/nAMD concern).<\/p>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ol>\r\n<hr data-start=\"6658\" data-end=\"6661\" \/>\r\n<h2 data-start=\"6663\" data-end=\"6705\">6. Bottom line on \u201cGLP-1 Drugs in LGMD\u201d<\/h2>\r\n<ul data-start=\"6707\" data-end=\"7054\">\r\n<li data-start=\"6707\" data-end=\"6925\">\r\n<p data-start=\"6709\" data-end=\"6925\"><strong data-start=\"6709\" data-end=\"6726\">What\u2019s valid:<\/strong> treating GLP-1 \/ GIP-GLP-1 agents as <strong data-start=\"6764\" data-end=\"6867\">potentially high-risk for functional decline in LGMD unless muscle-preservation is actively managed<\/strong>, and insisting on individualized risk\u2013benefit assessment.<\/p>\r\n<\/li>\r\n<li data-start=\"6926\" data-end=\"7054\">\r\n<p data-start=\"6928\" data-end=\"7054\"><strong data-start=\"6928\" data-end=\"6970\">What\u2019s <em data-start=\"6937\" data-end=\"6942\">not<\/em> currently evidence-based:<\/strong> saying they are <strong data-start=\"6987\" data-end=\"7020\">categorically contraindicated<\/strong> or uniquely toxic to LGMD muscle.<\/p>\r\n<\/li>\r\n<\/ul>\r\n","protected":false},"excerpt":{"rendered":"<p>Short version: There\u2019s no direct evidence that GLP-1 \/ GIP-GLP-1 drugs are inherently unsafe or absolutely contraindicated in LGMD, but there are very reasonable concerns about additional lean-muscle loss and frailty in someone who already has a primary myopathy. Any statement about \u201cGLP-1 drugs in LGMD\u201d is valid only if it\u2019s framed as \u201chigh-caution, individualized use,\u201d not \u201cnever use.\u201d \u00a0 1. What evidence actually exists in LGMD? I\u2019m not finding clinical trials or case series specifically testing GLP-1 RAs or tirzepatide in LGMD. Current LGMD drug headlines are about gene therapies or other experimental agents, not GLP-1s.Synapse+1 The recent safety scare you may have seen that mentions LGMD and a patient fatality is about an LGMD gene therapy program, not about GLP-1 drugs.Prime Therapeutics+1 So any statement about GLP-1s in LGMD is, by necessity, extrapolation, not direct data. 2. What do we know about GLP-1 \/ GIP-GLP-1 and muscle? a) Lean mass loss is real, but proportional Across large semaglutide and tirzepatide studies: Typically ~25\u201335% of the weight lost is lean mass, the rest is fat. This pattern holds for tirzepatide and high-dose semaglutide (STEP, SURMOUNT and related analyses).Wiley Online Library+1 Reviews of GLP-1 RAs and sarcopenia conclude that: They&#8230;<\/p>\n<div class=\"more-link-wrapper\"><a class=\"more-link\" href=\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\">Continue reading<span class=\"screen-reader-text\">LGMD and GLP-1 Drugs, 2025<\/span><\/a><\/div>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[9],"tags":[],"class_list":["post-216","post","type-post","status-publish","format-standard","hentry","category-symptoms","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>LGMD and GLP-1 Drugs, 2025 - LGMD1D Foundation and Autosomal Dominant LGMD Registry<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"LGMD and GLP-1 Drugs, 2025 - LGMD1D Foundation and Autosomal Dominant LGMD Registry\" \/>\n<meta property=\"og:description\" content=\"Short version: There\u2019s no direct evidence that GLP-1 \/ GIP-GLP-1 drugs are inherently unsafe or absolutely contraindicated in LGMD, but there are very reasonable concerns about additional lean-muscle loss and frailty in someone who already has a primary myopathy. Any statement about \u201cGLP-1 drugs in LGMD\u201d is valid only if it\u2019s framed as \u201chigh-caution, individualized use,\u201d not \u201cnever use.\u201d \u00a0 1. What evidence actually exists in LGMD? I\u2019m not finding clinical trials or case series specifically testing GLP-1 RAs or tirzepatide in LGMD. Current LGMD drug headlines are about gene therapies or other experimental agents, not GLP-1s.Synapse+1 The recent safety scare you may have seen that mentions LGMD and a patient fatality is about an LGMD gene therapy program, not about GLP-1 drugs.Prime Therapeutics+1 So any statement about GLP-1s in LGMD is, by necessity, extrapolation, not direct data. 2. What do we know about GLP-1 \/ GIP-GLP-1 and muscle? a) Lean mass loss is real, but proportional Across large semaglutide and tirzepatide studies: Typically ~25\u201335% of the weight lost is lean mass, the rest is fat. This pattern holds for tirzepatide and high-dose semaglutide (STEP, SURMOUNT and related analyses).Wiley Online Library+1 Reviews of GLP-1 RAs and sarcopenia conclude that: They&#8230;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\" \/>\n<meta property=\"og:site_name\" content=\"LGMD1D Foundation and Autosomal Dominant LGMD Registry\" \/>\n<meta property=\"article:author\" content=\"https:\/\/www.facebook.com\/LGMD.1D\" \/>\n<meta property=\"article:published_time\" content=\"2020-01-07T04:47:05+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-12-09T02:11:59+00:00\" \/>\n<meta name=\"author\" content=\"William Lowery MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"William Lowery MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\"},\"author\":{\"name\":\"William Lowery MD\",\"@id\":\"https:\/\/lgmd1d.org\/lgmdwp\/#\/schema\/person\/c25c3d3d3df3aca99f72ec9ab3c97cd3\"},\"headline\":\"LGMD and GLP-1 Drugs, 2025\",\"datePublished\":\"2020-01-07T04:47:05+00:00\",\"dateModified\":\"2025-12-09T02:11:59+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\"},\"wordCount\":874,\"commentCount\":0,\"articleSection\":[\"Symptoms\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\",\"url\":\"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/\",\"name\":\"LGMD and GLP-1 Drugs, 2025 - 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LGMD1D Foundation and Autosomal Dominant LGMD Registry","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/","og_locale":"en_US","og_type":"article","og_title":"LGMD and GLP-1 Drugs, 2025 - LGMD1D Foundation and Autosomal Dominant LGMD Registry","og_description":"Short version: There\u2019s no direct evidence that GLP-1 \/ GIP-GLP-1 drugs are inherently unsafe or absolutely contraindicated in LGMD, but there are very reasonable concerns about additional lean-muscle loss and frailty in someone who already has a primary myopathy. Any statement about \u201cGLP-1 drugs in LGMD\u201d is valid only if it\u2019s framed as \u201chigh-caution, individualized use,\u201d not \u201cnever use.\u201d \u00a0 1. What evidence actually exists in LGMD? I\u2019m not finding clinical trials or case series specifically testing GLP-1 RAs or tirzepatide in LGMD. Current LGMD drug headlines are about gene therapies or other experimental agents, not GLP-1s.Synapse+1 The recent safety scare you may have seen that mentions LGMD and a patient fatality is about an LGMD gene therapy program, not about GLP-1 drugs.Prime Therapeutics+1 So any statement about GLP-1s in LGMD is, by necessity, extrapolation, not direct data. 2. What do we know about GLP-1 \/ GIP-GLP-1 and muscle? a) Lean mass loss is real, but proportional Across large semaglutide and tirzepatide studies: Typically ~25\u201335% of the weight lost is lean mass, the rest is fat. This pattern holds for tirzepatide and high-dose semaglutide (STEP, SURMOUNT and related analyses).Wiley Online Library+1 Reviews of GLP-1 RAs and sarcopenia conclude that: They&#8230;","og_url":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/","og_site_name":"LGMD1D Foundation and Autosomal Dominant LGMD Registry","article_author":"https:\/\/www.facebook.com\/LGMD.1D","article_published_time":"2020-01-07T04:47:05+00:00","article_modified_time":"2025-12-09T02:11:59+00:00","author":"William Lowery MD","twitter_card":"summary_large_image","twitter_misc":{"Written by":"William Lowery MD","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/#article","isPartOf":{"@id":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/"},"author":{"name":"William Lowery MD","@id":"https:\/\/lgmd1d.org\/lgmdwp\/#\/schema\/person\/c25c3d3d3df3aca99f72ec9ab3c97cd3"},"headline":"LGMD and GLP-1 Drugs, 2025","datePublished":"2020-01-07T04:47:05+00:00","dateModified":"2025-12-09T02:11:59+00:00","mainEntityOfPage":{"@id":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/"},"wordCount":874,"commentCount":0,"articleSection":["Symptoms"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/","url":"https:\/\/lgmd1d.org\/lgmdwp\/symptoms\/have-symptoms-try-symptomate\/","name":"LGMD and GLP-1 Drugs, 2025 - 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