Modestly, on one trial, and only in people who also have type 2 diabetes. Maximum walking distance improved with an estimated treatment ratio of 1.13, 95% CI 1.06 to 1.21, over 52 weeks [1]. That is roughly 13% further than the placebo group managed, not 13% further than before. Whether a modest benefit justifies a large recurring bill is the question asked in is a GLP-1 worth what it costs.
What the walking trial tested
Between October 2020 and July 2024, 1,363 patients were screened and 792 randomized to semaglutide or placebo. All had symptomatic peripheral artery disease and type 2 diabetes. A quarter were female, the median age was 68, and the primary outcome was the change in maximum walking distance at week 52.
The semaglutide arm reached a median 1.21 times its own baseline. The placebo arm reached 1.08 times. The gap between those is the result, and it is easy to misread in the flattering direction. The drug did not make people walk 21% further. It made them walk about 13% further than they would have anyway.
Who the trial does not cover
Everyone in it had type 2 diabetes. The authors say so in their own interpretation and call for studies in peripheral artery disease without it. A reader with claudication and no diabetes sits outside what this result establishes. That is a limit worth stating rather than glossing.
What the class does to the events behind the symptom
Claudication is the symptom. The risk underneath it is arterial disease elsewhere. A meta-analysis pooled 21 randomized trials covering 99,599 patients across eight drugs in this class, with a mean follow-up of 2.4 years [2]. Major adverse cardiovascular events fell, incidence rate ratio 0.87, 95% CI 0.83 to 0.91, number needed to treat 66.
All-cause death came in at 0.88, NNT 121. Cardiovascular death at 0.87, NNT 170. Both were graded high certainty. Harms ran the other way: gastrointestinal disorders rose 63% and gallbladder disorders 26%, which matches the gallbladder evidence.
One study not to rely on
Risk-factor control matters in peripheral artery disease, and blood pressure is the one most often quoted. A national survey analysis reported blood pressure at target in 66% of GLP-1 users against 24% of non-users [3]. The entire user arm is 45 respondents, weighted up to represent 994,028 adults.
Three things disqualify it here. It is cross-sectional, so nothing establishes which came first. Its users had a substantially higher BMI, 37.25 against 31.22, which points at care intensity rather than pharmacology. And the data run to March 2020, before the obesity indication. Blood pressure does fall on these drugs in randomized trials, as the trial evidence sets out. This is not that evidence.
Setting it against the price
Across the 398 injected semaglutide figures recorded here, the median billed rate is $179 a month, read September 2026. That is $2,148 for the 52 weeks this trial ran. It buys, on this evidence, about a 13% relative improvement in how far someone can walk before stopping.
Whether that is worth it is a judgment rather than a calculation, and nobody selling the drug will make it for a buyer. The trial puts a real number on one side. The fees outside the headline sit on the other. Two pages collect them: what a GLP-1 costs per month and the headline is not the bill.