GLP-1 drugs forever; Ozempic holiday; Pairing meds with bariatric surgery; new data on oral GLP-1 medication; $20M funding for weight-inclusive primary care.
Are GLP-1 drugs a forever commitment? is the topic de jour from Shelby Livingston at Business Insider.
Tina Reid at AXIOS notes a pairing of GLP-1 drugs with bariatric surgery; as opposed to an either or approach.
Structure Therapeutics, releaseddata from oral GLP-1 study drug GSBR-1290, in 94 patients with weight loss of just 3.5%, over 12-weeks.
knownwell, an in-person and virtual, weight-inclusive primary care and metabolic health company, announced a funding raise of $20M.
Ozempic holiday – abc News reviewsskipping a dose over Thanksgiving and the Christmas holiday, to ‘… feel less uncomfortably full at meals.’
NEWS
A new lawsuit states that the manufacturers of anti-obesity meds ‘…knowingly advertising and selling the products despite their ability to cause severe gastrointestinal issues…’ in reporting from Riley Brennan at Benefits Pro.
Plaintiff Billy Farley claims that three months after taking Ozempic, she was suffering from a life-threatening bowel injury, which required an extensive, eight-hour surgery, and now ‘…continues to suffer from constant abdominal pain, nausea and vomiting.’
Structure Therapeutics, a US and China based biotechnology company, released new data from its study drug GSBR-1290, an oral GLP-1 agonist drug, in 94 patients.
The drug was safe and tolerable, there was a reduction in blood glucose as per HbA1c of 1% in diabetics, and weight loss of up to 3.5%, over a 12-week study period.
Non-diabetic patients achieved weight loss of almost 5%, which is way lower than the range of 15-21% on injectable GLP-1 drugs – though the period for the GSBR-1290 drug study was only three months.
This data was not looked upon pleasantly by investors, with the Nasdaq share price dropping by almost half, from $59 last week, to $33 this week, and cutting the market cap of the company down to $1.2B, from a previous high of almost $3B.
knownwell, an in-person and virtual, weight-inclusive primary care and metabolic health company, announced a funding raise of $20M, led by industry veterans at Andreesen Horowitz, or a16z.
The company is headed by Brooke Boyarsky Pratt who has had lifelong obesity, and Dr. Angela Fitch, President of the Obesity Medicine Association.
The approach is to offer weight-inclusive care, in a shame and blame-free care model, within primary care clinics and on a technology platform, incorporating ‘…AI-powered patient stratification, asynchronous communication, and provider workflow enablement tools.’
With over 40% of the U.S adult population and almost 20% of children and adolescents suffering from obesity in the U.S., I am all for compassionate, whole-person care; but how will knownwell measure and drive better clinical outcomes?
Despite this, I wholeheartedly welcome investment in the obesity and medical care start-up space, for us to assume deliberate focus on accessible, highest quality, cost permissive care, to the 110 million Americans that need it, and counting!
Dr. Angela Fitch, of knownwell, writes an Op-Ed in The Wall Street Journal, on the role of new GLP-1 medications as ‘…a life-changer.’
She reviews their impact beyond weight loss, on a reduction in strokes, heart attacks, kidney disease, and to distance the approach from a long-standing ‘…cultural desire for thinness.’
Just as there has been stigma associated with treatments for HIV and AIDS, depression, anxiety and autism, there needs to be a ‘…reinvigorated commitment to address obesity as a chronic, multifaceted condition demanding comprehensive, specialized care.’
The three key tenets, in my mind, are access to care, especially for the underserved, a multimodal approach to treatment, that is whole-person in its initiation and onward execution, and a focus upon chronic disease resolution with a concomitant reduction in total costs of care, at the individual level, and for populations.
OPINION
A pill form of GLP-1 drugs sounds nice, but ‘…Developing oral obesity drugs that are as tolerable and effective as their injectable counterparts has so far been a challenge…’ writes Yasmin Tayag at The Atlantic.
Injectable meds such as Ozempic and Mounjaro work well due to the higher doses that can be packed into the shot, versus a pill, that must be taken daily or sometimes twice daily, with additional restrictions for when to eat both before and after taking the tablet.
Eduardo Grunvald, an obesity-medicine physician at UC San Diego Health, said that ‘…assuming pills are preferable to shots is a knee-jerk reaction.’
The side effects of pills and discontinuation rates can also be higher than with the injectable pen forms; but the pills may be easier and cheaper to manufacture – important in the current era of supply chain shortages.
And on the other end of the spectrum is Amgen’s research into a once-monthly injection, and Novo’s med that would only need to be taken three times a year – wow, that in my mind would be an even more important game-changer.
And almost akin to a vaccine-type approach to obesity care.
Are GLP-1 drugs a forever commitment? is the topic de jour from Shelby Livingston at Business Insider.
Or can a healthcare company such as Virta Health, Noom or WeightWatchers, really get you off the $1,000 a month medication… with diet and exercise?
Well respected obesity medicine physician Dr. Michael Albert says ‘…It’s very unscientific…’ and further that ‘…It’s unethical… because you’re misrepresenting the science and making promises that aren’t supported in the science.’
The evidence states that coming off the drug leads to weight regain and a return of chronic conditions; just imagine someone coming off their beta blocker meds prescribed to avoid angina – their angina symptoms would be highly likely to return.
Is this an approach to align with health plans that want to cut costs – at the risk of harming patients physically, as well as emotionally.
As Dr. Albert puts it, we want to avoid the ‘…potentially devastating emotional toll of programs that rip medication away from a patient…’ but not with an untested approach.
Dr. Robert Kushner at Northwestern University in Chicago adds ‘…it all needs to be researched. We can’t just go out there and do it.’
There is an unpublished academic paper that has been submitted for peer review on the topic, with data showing a maintenance of weight loss after 12 months off the medication; I suggest we await formal publication prior to make any conclusions.
And remember, the National Health Service in the U.K. approved GLP-1 meds, but only for a maximum period of two years – what will happen to these patients is an important and yet unrecognized concern too.
Going back to Virta and others, the approach to quit Wegovy, Ozempic or other GLP-1 meds is too much of a promise of a promise, and right now, without scientific credibility to adopt for sure.
Tina Reid at AXIOS notes a pairing of GLP-1 drugs with bariatric surgery; as opposed to an either or approach.
From a claims database over the past five years, data shows that 16% or 1 in 6 bariatric surgery patients were later prescribed a GLP-1 in 2023.
Dr. Enrique Elli, a bariatric surgeon at the Mayo Clinic, said ‘…As a surgeon, I welcome these drugs because I think that will make bariatric surgery even more effective…’ to which I wholeheartedly agree.
Just think of it as medication therapy to improve the outcome before or after someone has a bowel tumor removed, known as chemotherapy; and in the case of obesity care, underpinned by effective lifestyle therapies too.
At the age of 13 years, Maggie Ervie from Marceline, Missouri, was prescribed Victoza, and older version of the current GLP-1 meds, and six months later, underwent bariatric surgery.
An American Girl in the Ozempic Era is the title of Lisa Miller’s excellent article in The Cut; relaying Maggie’s story of ill health, psychological and social upset, as well as that of her mother Erika who ‘…struggled with her weight her entire life and feels the experience defined her.’
Maggie has now joined the cheerleading team, is messaging with boys on Snapchat, she is back on the first page of the growth chart, her blood work is normal, and she is ‘…finally being a normal teenager.’
Ozempic holiday – abc News reviewsskipping a dose over Thanksgiving and the Christmas holiday, to ‘… feel less uncomfortably full at meals and brings up fewer questions from friends and family.’
This is unlikely to cause harm, though ultimately brings into question on whether patients are on this drug for a medical condition, or as a tool for vanity purposes.
DATA
Daniel Drucker, a well-known obesity medicine researcher from Toronto, Canada, together with colleagues, published data on GLP-1 drugs and their impact on inflammation within the central nervous system.
The study patients were laboratory mice, and whilst clinical impact was not the goal of the research, this could pave early effrots to define the role of GLP-1 meds on diseases of the brain such as Parkinson’s disease and Alzheimer’s disease.
