Hello everyone, I hope you are enjoying the weekend, and trust you enjoyed the fireworks, summer sunshine and celebrations of American Independence Day this past week.
It was a slower news week in the obesity management space, perhaps a function of summer vacations — we are taking ours’ this week — but the growing focus on the GLP-1 medications continues unabated.
Kind regards, Raj.
AT A GLANCE
- Novo Nordisk has ‘…sued US pharmacies making and selling versions of semaglutide…’ in Florida and Tennessee federal courts.
- Alfie Health, a new company utilizes AI ‘…to make obesity care more efficient and effective with its algorithm, ObesityRx.’
- Yasmin Gagne at Fast Company states ‘…Medication-assisted obesity care is going mainstream…’ though follows that the drugs ‘…could cost employers a lot of money.’
- A welcome review on prediabetes in The Lancet Diabetes & Endocrinology, the precursor to type 2 diabetes.
NEWS
- Novo Nordisk ‘…bought more than 457,000 meals to educate doctors and other prescribers about its portfolio of drugs known as GLP-1 agonists…’ comprising nearly 12,000 prescribers who received more than a dozen meals last year, with one doctor recoding 193 paid meals, at a total cost of $9 million, as per Nicholas Florko in STAT News. It is true from my experience as a clinician that ‘…providing modest meals to healthcare professionals… is a standard pharmaceutical industry practice…’ in relation to a statement from Novo Nordisk. Indeed, the ‘…average cost was just under $20, though some cost several hundred dollars – the most expensive being $639…’ with most to be ‘…coffee, snacks, or lunch.’ Nearest competitor in the anti-obesity medication space, Eli Lilly ‘…bought doctors 184,000 meals to discuss those drugs…’ that ‘…cost the company roughly $3.5 million.’ The clarity here is that there is a huge market, from up to $30B, to over $100B in this space, and marketing to those who are able to prescribe medications, over and above to patients themselves, is big business.
- The SELECT trial, due to report in September 2023, on ‘…whether long-term treatment with a weight loss drug [semaglutide] can meaningfully improve patients’ cardiovascular health…’ is profiled in STAT News by Damian Garde, Andrew Joseph and Elain Chen. Martin Lange, executive vice president of development at Novo Nordisk stated ‘…Select has the potential, if everything goes right, to virtually become a game changer and a landmark trial…’ with which I agree fully, to drive the management of obesity as a clinical disease, with reduction in cardiovascular events such as heart attacks, and stroke. The SELECT study is further described in the article, on 17,500 patients without diabetes, half of whom receive regular injections of Wegovy, versus placebo; with a goal to ‘…significantly delay the occurrence of rates of heart attack, stroke, and cardiovascular death.’ The key piece here is for semaglutide and other drugs in the GLP-1 class to show outcomes beyond weight loss, such that health plans, employers, and Medicare, would change their stance to pay for them to be prescribed to their beneficiaries. In closing, I do agree with Novo Nordisk CEO Lars Fruergaard Jørgensen that ‘…Addressing obesity… [is] one of the best investment cases for health care systems.’
- Emma Court reports on a follow up to the recent law suit against medical spas and weight loss clinics that prescribe compounded versions of semaglutide, Novo Nordisk has ‘…sued US pharmacies making and selling versions of semaglutide… in Florida and Tennessee federal courts.’ The company states in the suit that ‘…Ignoring drug-approval requirements provides defendant an unfair competitive advantage over pharmaceutical manufacturers like Novo Nordisk…’ and continues that ‘…it puts patients at risk by exposing them to drugs that have not been shown to be safe or effective.’
- A newcomer to the weight loss market is Alfie Health, based upon a desire ‘…to make obesity care more efficient and effective with its algorithm, ObesityRx…’ from reporter Rebecca Torrence this week. Co-founders Alexander Singh and Rohit Rustagi just announced their ‘…$2.1 million in pre-seed funding led by Y Combinator and Nina Capital…’ following results of study of 300 patients, who ‘…lost an average of 10% to 15% of their body weight…’ without GLP-1 medications. The ObesityRx algorithm ‘…can adjust its treatment recommendations over time as patients record their weight-loss progress on Alfie Health’s app…’ based upon the company’s slide deck. I certainly think that the hot space that is AI right now, coupled with GLP-1 and obesity care hype – has high potential to succeed.
OPINION
- Onward from the recent OASIS 1 publication in The Lancet, as per the American Diabetes Association meeting, Hilary Brueck at Business Insider reports a new ‘…pill version of semaglutide for weight loss could soon be coming to a pharmacy near you…’ and that it ‘…could be a nice option for people who are afraid of needles.’ More relevant is that ‘…oral semaglutide is swallowed, not injected, it requires a special daily routine…’ to be taken on ‘…an empty stomach…’ and then ‘…have to wait at least 30 minutes before drinking any beverages, including coffee, or having breakfast.’ The gist of the story is that a once-weekly injection may be more convenient than remembering to take a once-daily pill, with the former leading to superior medication adherence. I am sure a trial is already in the planning on this one.
- Starting with Elon Musk, Kim Kardashian, and Jimmy Kimmel at the Oscars ceremony, the Ozempic media hype seems to be taking forward charge with oral versions of semaglutide that are as effective as the injections, and newer versions of GLP-1 medications that are almost as effective as some forms of bariatric surgery. Fast Company reporter Yasmin Gagne states ‘…Medication-assisted obesity care is going mainstream…’ though follows that the drugs ‘…could cost employers a lot of money.’ Rekha Kumar, chief medical officer at Found, a digital health company that specializes in comprehensive weight management solutions goes further, with GLP-1 type medications being ‘…something theoretically 70% of the population could qualify for, and that would bankrupt employers and insurance companies.’
- Dr. Omer Awan, a practicing radiologist at the University of Maryland School of Medicine, writes in Forbes regarding Ozempic: ‘…wide-scale adoption of the drug is not the solution for obesity.’ He continues that obesity ‘…is a chronic medical condition that requires a multifaceted approach for treatment…’ with intent to enhance the ‘…overall health and well-being of individuals, and not necessarily decreasing the number on the weight machine.’ This is a tough one, as there is no doubt that weight and BMI are intimately related to occurrence, severity, and persistence of obesity related diseases such as hypertension, type 2 diabetes, sleep apnea, osteoarthritis of the hip and knee, and polycystic ovarian syndrome. Dr. Awan simply states the ‘…public health message to treat obesity should be one of lifestyle modification, not the use of a drug that will affect just one aspect of the disease, namely weight.’ I am not an advocate for the either/or approach – we need an and approach to intervention, that is multimodal, dynamic, and individualized to the person, the whole person, and achieves the desired outcomes of care.
- Dan Skovronsky, Chief Scientific Officer at Eli Lilly is quoted in STAT News ‘…when we look back at the 2020s and ’30s, we’re going to say, Wow. This is when we realized that obesity was something we could deal with…’ akin to smoking cessation and cancer. The article focuses upon the successful leadership of Skovronsky and Dan Ricks, CEO at Eli Lilly, with respect to drug treatments for obesity and Alzheimer’s, that have ‘…driven Lilly shares up by 400% in five years, and the company’s market capitalization now exceeds $400 billion.’
- The issue of medication adherence, with specific mention of GLP-1 medications, over a multi-year period, is discussed by Matt Reynolds in WIRED, simply as ‘…there are all kinds of reasons people stop taking drugs.’ Whilst clinical trials last for one to two years, the necessity to take medications for obesity, a chronic disease, is lifelong. Side effects, regular injections, and cost, are common issues for stopping medication, with unknown outcomes beyond weight recurrence.
DATA
- A welcome review on prediabetes in The Lancet Diabetes & Endocrinology, the precursor to type 2 diabetes. It is quite remarkable that ‘…prediabetes will progress into type 2 diabetes at a rate of 5–10% per year…’ and ‘…faster for certain ethnicities (eg, South and East Asian people)…’ which is certainly something I am aware of – as my primary care physician once told me, you cannot change your genes. There is also a higher rate of progression for ‘…individuals who are older, have overweight, or have glycaemic values already close to the boundary of diabetes.’ The general gist of the article is to ‘…defer, prevent, or reverse the progression to diabetes…’ with intent to intervene earlier, rather than at a later stage. The key part here is who to screen, when to screen, how to treat, and for what period of time.
Kind regards, Raj
