Commentary
Article
Despite Demonstrated Efficacy, The Future of Antiobesity Medications Depends Largely On Supply
Author(s):
Pricing is also a key issue, as many insurance plans do not cover these medications’ use for obesity.
Obesity is common in the United States and is a major health issue associated with numerous diseases. Nearly 1 in 3 adults (30.7%) are overweight, including more than 1 in 3 men (34.1%) and more than 1 in 4 women (27.5%). More than 2 in 5 adults (42.4%) have obesity, including severe obesity. About 1 in 11 adults (9.2%) have severe obesity.1
Today, there are numerous medications available in the market ranging from OTC to prescription drugs. The current trend has seen a large increase in the use of 2 drugs mainly known as semaglutide (Ozempic; Novo Nordisk) and tirzepatide (Mounjaro; Lilly).
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Semaglutide, developed by Novo Nordisk, received approval from the FDA in 2017 as a medication for type 2 diabetes under the brand name Ozempic. It is available in various strength (0.25mg, 0.5mg, 1 mg, and 2 mg). Semaglutide also received FDA approval in 2021 for chronic weight management under the brand name Wegovy (Novo Nordisk), also available in various strength (0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg).2
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics the naturally occurring GLP-1 hormone that is released by the intestines into the bloodstream within minutes after ingesting food. Semaglutide regulates food intake and promotes weight reduction by suppressing appetite and increasing the feeling of fullness.
A 68-week medical study of 1961 adults with excess weight or obesity showed that 83% of adults taking semaglutide lost 5% or more body weight, compared to 31% taking placebo. Additionally, 66%lost 10% or more body weight compared to 12% taking placebo; 48% lost 15% or more body weight compared to 5% taking placebo; and 30% of people taking semaglutide lost 20% or more body weight compared to 2% of people taking placebo.2
The common adverse effects associated with semaglutide include nausea, diarrhea, vomiting, constipation, stomach pain, headache, fatigue, upset stomach, dizziness, feeling bloated, belching, and gas. Serious adverse effects can include pancreatitis, gall bladder problems, kidney problems, and hypoglycemia.2
Tirzepatide received approval from the FDA in May 2022 under the brand name Mounjaro (Lilly) for treatment of type 2 diabetes. The medication is availablein various strength(2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg). The drug is not currently approved for weight loss, but the company has filed for that indication with the FDA.
Tirzepatide is a GIP and GLP-1 agonist. Despite the similarities between the 2 incretins, it should be noted that although GIP activity is mainly pancreatic, GLP-1 activity is systemic.3
Clinical trials for tirzepatide in patients with obesity show a marked impact of the medication on obesity, although it requires ongoing treatment to maintain the weight loss. In an 88-week trial, 783 participants were given either 10 mg or 15 mg of tirzepatide for the first 36 weeks, followed by randomization to either tirzepatide or placebo for the remaining 52 weeks. The results showed that those who continued treatment with tirzepatide for the entire 88 weeks experienced a total weight loss of 26% of their body weight.4
The major adverse effects of the drug include risk of thyroid C-cell tumors, pancreatitis, hypoglycemia, acute kidney injury, severe gastrointestinal disease, and acute gall bladder disease.4
The treatment of obesity has progressed rapidly in recent years. Clinicians have seen a 300% surge in the use of antiobesity medications over the last 3 years alone,5 although the rate of future prescription volumes will largely depend on whether manufacturers can resolve supply shortages and keep up with demand. Pricing is also a key issue, as many insurance plans do not cover these medications’ use for antiobesity.
References
1. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960-1962 through 2017-2018. CDC. Updated January 29, 2021. Accessed November 7, 2023. https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htm
2. Wegovy. Prescribing information. Novo Nordisk. Accessed November 7, 2023. Wegovy.com
3. Fisman EZ, Tenenbaum A. The dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide: a novel cardiometabolic therapeutic prospect. Cardiovasc Diabetol. 2021;20(225).
4. Chen S. Diabetes drug Mounjaro shown to have extraordinary weight loss for people without diabetes. diaTribe Learn. Updated October 23, 2023. Accessed November 7, 2023. https://diatribe.org/diabetes-drug-mounjaro-shown-have-extraordinary-weight-loss-people-without-diabetes
5. Constantino AK. Ozempic, Wegovy drug prescriptions hit 9 million, surge 300% in under 3 years. CNBC. Updated September 27, 2023. Accessed November 7, 2023. https://www.cnbc.com/2023/09/27/ozempic-wegovy-drug-prescriptions-hit-9-million.html
