Efficacy and safety of once-weekly subcutaneous semaglutide 2.4 mg for the management of overweight or obesity in Asian populations: A systematic review, meta-analysis and meta-regression of randomised trials.

AIMS: The rising prevalence of overweight and obesity among Asian populations poses a critical public health concern. Semaglutide 2.4 mg, a glucagon-like peptide-1 receptor agonist, has demonstrated promising weight-reduction effects in global populations, but its efficacy and safety profile in Asians remain less comprehensively examined. This meta-analysis aimed to evaluate the effectiveness and tolerability of semaglutide 2.4 mg compared to placebo in Asian individuals with overweight or obesity. MATERIALS AND METHODS: A systematic literature search was conducted in Medline, ScienceDirect, Europe pubMed central (PMC) and the Cochrane Library up to 15 June 2025. Eligible studies were randomised controlled trials (RCTs) comparing semaglutide 2.4 mg with placebo in overweight or obese Asian individuals. Risk of bias was evaluated using the Cochrane Risk of Bias v2 tool. Pooled outcomes were analysed using random-effects models to estimate mean differences (MDs) and odds ratios, and heterogeneity was assessed with the I statistic. RESULTS: Five RCTs involving 2614 participants met the inclusion criteria. All trials were deemed to have a low risk of bias. Our meta-analysis indicated that treatment with semaglutide 2.4 mg resulted in significantly greater reductions in body weight (MD: -8.20%; 95% confidence interval [CI]: -10.06 to -6.35; I = 84%), waist circumference (MD: -6.47 cm; 95% CI: -8.26 to -4.68; I = 84%), body mass index (MD: -3.22 kg/m; 95% CI: -4.01 to -2.44; I = 66%) and systolic blood pressure (MD: -3.46 mmHg; 95% CI: -5.29 to -1.62; I = 28%) compared to placebo. A higher proportion of participants in semaglutide 2.4 mg achieved weight loss exceeding 5%, 10% and 15%. Gastrointestinal symptoms were the most commonly reported adverse effects, generally mild to moderate and self-limiting. CONCLUSIONS: Semaglutide 2.4 mg significantly improves weight-related and cardiometabolic outcomes in Asian adults with overweight or obesity. Further studies are warranted to assess long-term effects, real-world applicability and variability across subpopulations.