Eli Lilly Boosted & Novo Nordisk Down; The Wild West of Online GLP-1 Sites; Bowling Green, KY aka ‘Ozempictown’; Hims Doubles Down on Compounded GLP-1s

AT A GLANCE

  • Forget Ozempic says Business Insider – an under-the-radar antiaging supplement is the next hot commodity in Hollywood.
  • STAT notes Eli Lilly boosts 2024 revenue guidance by $3 billion, driven by massive sales of Mounjaro and Zepbound.
  • STAT reports an underwhelming earnings report and ongoing questions about increasing competition that sent Novo Nordisk’s shares down.
  • Dr. Scott Kahan says in STAT of online prescribers ‘…The world of obesity and weight loss treatments and products have forever been a wild west…’
  • Bloomberg writes America’s weight-loss drug capital isn’t Hollywood or Manhattan. It’s Bowling Green, Kentucky.
  • JAMA Network Open on the safety and risk assessment of no-prescription online semaglutide purchases.
  • Direct-to-consumer telehealth company Hims & Hers hypes compounded GLP-1s during its Q2 earnings call, from Modern Healthcare.

NEWS

  • Forget Ozempic says Business Insider – an under-the-radar antiaging supplement is the next hot commodity in Hollywood.
    • NAD supplements promise to replenish your body’s natural supply of a critical molecule called nicotinamide adenine dinucleotide, that underlies the conversion of protein, fat, and carbohydrate into energy.
    • Nutrition experts have known for nearly a century how important this coenzyme is to our health.
    • Robert Fried, a moviemaker-turned-CEO of the NAD supplement company ChromaDex said NAD boosting is generally good ‘…when you want to increase your resiliency…’ – maybe you’re jet-lagged, you pulled an all-nighter, or you’re feeling just a little bit sick.
    • Now, elite biohackers and wellness influencers are leaning hard into trendy NAD-boosting drips, powders, and supplement capsules promising to keep them young, vibrant, and strong, such as Hailey Bieber, a 27-year-old model.
    • Bieber has injected NAD+ boosters – the antiaging elixirs that have joined the ranks of Ozempic and Botox as staples of elite wellness routines.
  • Bloomberg on Eli Lilly expects its blockbuster weight-loss drug to officially come out of shortage in the US in the coming days, said CEO David Ricks.
    • This will certainly threaten the billion-dollar industry of copycat versions of the in-demand drugs.
    • Shares of Hims & Hers Health Inc., which sells a compounded version of Wegovy but not Zepbound, fell as much as 16%, the most in more than three years, on Ricks’ comments.
    • The FDA’s shortage list says two doses of Lilly’s drug used for weight loss and two doses for diabetes are only available in limited quantities through July.
    • The shortage of Novo’s Wegovy is listed as indefinite.
  • STAT notes Eli Lilly boosts 2024 revenue guidance by $3 billion, driven by massive sales of its GLP-1-based diabetes and obesity drugs Mounjaro and Zepbound.
    • In Q2, sales of Mounjaro brought in $3.1 billion, and Zepbound at $1.2 billion, with both higher than expectations.
    • Lilly’s shares surged over 7%.
  • On the contrary, STAT reports an underwhelming earnings report and ongoing questions about increasing competition in the booming obesity medicine field sent Novo Nordisk’s shares down.
    • The company lowered its operating profit guidance to 20% to 28%, down from the 22% to 30% it forecasted in its last earnings report.
    • CFO Karsten Knudsen said on a call with reporters ‘…This is a quarterly blip.’
    • Novo also said Wednesday it was pulling regulatory submissions in the U.S. and Europe to expand the use of Wegovy for a common type of heart failure, saying that waiting for more data on cardiovascular outcomes could bolster its case, in the not-so-distant future.

OPINION

  • JAMA review on obesity in adolescents.
    • Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems.
    • Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.
    • Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.
    • Lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction.
    • Newer antiobesity medications, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment.
    • Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year.
    • Determining the long-term durability of all obesity treatments warrants future research.
  • JAMA Patient Page on obesity in adults.
    • Obesity is a condition of excess body fat that affects 800 million people worldwide and approximately 42% of adults in the US.
    • Obesity leads to a higher risk of death, heart disease, high blood pressure, diabetes, high cholesterol, gallbladder disease, metabolic dysfunction–associated steatotic liver disease, stroke, sleep apnea, osteoarthritis, depression, anxiety, and certain cancers (such as breast and colorectal cancers).
    • Intensive behavioral programs can achieve weight loss of 5% to 10% after 6 to 12 months.
    • FDA-approved injection medications for obesity include liraglutide, semaglutide, and tirzepatide; along with healthy lifestyle changes, they can result in an 8% to 21% weight loss.
    • Surgery (laparoscopic gastric sleeve gastrectomy, Roux-en-Y gastric bypass) results in weight loss of 25% to 30% at 12 months.
  • Dr. Scott Kahan, director of a weight management clinic in Washington, D.C. states in a STAT article ‘…The world of obesity and weight loss treatments and products have forever been a wild west…’ of online prescribers.
    • He continues ‘…While there’s a legitimate core of the field, far more that surrounds it is bogus and nonsense and predatory.’
    • Virtual weight loss platforms, obesity physicians acknowledge, are the product of a broken system.
    • There are more than 100 million people in the United States with obesity, and only 5,000 specialists.
    • But sadly, some services provide prescriptions based on nothing more than a glorified Google form, and without careful screening, patients could easily be handed medications that harm them.
    • Caroline Apovian at Brigham and Women’s Hospital adds many online companies ‘…don’t really understand that it’s not a matter of, “Just take this drug for three months and lose the 50 pounds and you’re done.”
  • Bloomberg writes America’s weight-loss drug capital isn’t Hollywood or Manhattan.
    • It’s Bowling Green, Kentucky.
    • Bowling Green, Kentucky’s third-largest city, with 74,000 residents, is perhaps best known as the home of the GM assembly plant where Chevrolet Corvettes are manufactured.
    • Residents say there’s not much to do besides eat, and there are plenty of options for that.
    • Bowling Green can now boast of something else: It’s Ozempictown, USA, with the highest concentration of people with weight-loss drug prescriptions in the country.
    • At least 4% of residents have received prescriptions to GLP-1 medications in the past year or so; prescription rates in Brooklyn, New York, and the Miami area are closer to 1%.
    • Around town, family-run pharmacies have started mixing up their own versions of the drugs, and they’re making a fortune.
    • Med spas and weight-loss clinics, which will write prescriptions for anyone looking to lose a few pounds, are competing for business—sometimes within blocks of one another.

DATA

  • JAMA Network Open publishes data from the Mayo Clinic on digital storytelling as an intervention to improve HbA1c levels among Hispanic adults with type 2 diabetes.
    • The intervention group viewed a 12-minute digital storytelling video.
    • The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring).
    • Participants were provided access to the storytelling video as an application on their mobile phones and/or a DVD, flash drive, and web link.
    • From 451 study participants in the randomized trial, there was a small improvement in mean HbA1c level in the intervention group from 9.1% to 8.4%.
    • Acceptability and narrative quality of the intervention were high.
    • I admire the robust scientific approach, and the focus upon a minority group that is more likely to develop complications and die from type 2 diabetes than the US general population.
    • In addition, the study team partnered with community members in developing digital narratives that described individuals’ experiences living with diabetes.
    • Engaging communities increases the likelihood that interventions are culturally tailored to patients and sustainable after the research is complete.
    • Bravo!
  • JAMA Network Open on the safety and risk assessment of no-prescription online semaglutide purchases.
    • Commenting upon widespread media coverage, viral social media exposure, and celebrity endorsements, academics from Hungary and San Diego conducted a risk assessment of semaglutide online sourcing.
    • From 134 illegal online pharmacies, six online vendors offered semaglutide products and were included in test buys; although genuine Ozempic scored the full 22 points on the checklist, test purchased products scored 8 or 9 with clear discrepancies in regulatory registration information, accurate labeling, and evidence products were likely unregistered or unlicensed.
    • Of concern, measured semaglutide content substantially exceeded the labeled amount in each sample by 29% to 39%, meaning that users could receive up to 39% more semaglutide per injection.
    • In summary, semaglutide products are actively being sold without prescription by illegal online pharmacies, with vendors shipping unregistered and falsified products.

DR.RAJESH TWENTLY 30 HEALTH


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