Anissa Durham on STAT ‘…New obesity drugs are seemingly everywhere. Black Americans feel left out.’
From Nature Medicine, semaglutide lowered rate of long-term kidney outcomes by 22%, compared to placebo, at four years.
Blue Health Intelligence reports less than half of those prescribed stay on the medication for 12 weeks or more.
In JAMA, Chinese adults with BMI over 28, or over 24 with one weight-related co-morbidity, had 17.5% total weight loss, with 15mg tirzetapide at week 52.
NEWS
CNN on Nestle ‘…releasing a lineup of frozen food for people on Ozempic and other GLP-1 drugs.’
The new frozen food brand is called Vital Pursuit; with 12 portion-controlled meals, high in protein plus fiber, ‘…intended to be a companion for GLP-1 weight loss medication users and consumers focused on weight management.’
The meals consist of sandwich melts, pizzas and bowls; in counter to the old-school approach of Lean Cuisine diet-focused meals – also owned by Nestle.
Nestle North America CEO Steve Presley wants to send ‘…a signal to investors and stakeholders that Nestle is looking at weight-loss drugs and is responding to the opportunity.’
Deena Beasley at Reuters reports BMO Capital Markets now estimates annual weight-loss drug sales reaching $150 billion by 2033, up from a year-ago forecast of over $100 billion.
In addition, Leerink forecasts annual sales of $158 billion by 2032.
Michael Kleinrock at IQVIA Institute for Data Science says ‘…it is very unusual to have a medicine that is capturing the imagination of millions of people.’
With global spending on obesity medications at $24 billion last year, IQVIA estimates the market size could reach $131 billion by 2028.
Modern Healthcare writes that Novo Nordisk blames US health system after Sanders’ Wegovy criticism.
Novo Nordisk said it ‘…retains about 60% of the list price of Ozempic and Wegovy in the US after rebates and fees paid to middlemen.’
In a letter to Senator Bernie Sanders, Novo said it is prepared to work with lawmakers to address ‘…systemic issues so that everyone who can benefit from its medicines is able to get them…’ with net prices expected to continue to decline.
Novo has spent over $10 billion to develop GLP-1 medicines, with Ozempic expected to generate some $18 billion in sales this year.
At a 60% gross margin, that is a pretty healthy rate of return.
OPINION
Two weeks ago, I noted South Park; The End of Obesity would not be politically correct, but rather offensive and controversial.
I have had a pretty big change of heart having watched the episode – it is very good and spot on.
Cartman is prescribed an alternative to semaglutide as he cannot afford $1,200 per month… watching Lizzo videos.
This leads into the very apt line ‘…Rich people get Ozempic, poor people get body positivity.’
A TV ad for Lizzo states it ‘…Makes you feel good about your weight, and it costs 90% less than Ozempic. In case studies, 70% of patients on Lizzo no longer cared how much they weighed.’
Randy Marsh, Shelley’s father accidentally gets addicted to Ozempic, attending several Ozempic parties.
The Navigating the American Healthcare System song is pure class, not just in relation to weight loss, but a great parody of all the ails of this $4.2Tr behemoth.
In addition, Stan, Kyle, Kenny, Butters and Cartman start their own compounding pharmacy, Big Cereal schemes to take down Big Pharma, and there is a final showdown between Ozempic mums and Cereal Mascots.
Whilst there is the usual mix of foul language and bloody gun-blazon scenes, the sharp satire from Trey Parker and Matt Stone is eerily realistic.
Anissa Durham, a health data reporter for Word In Black writes in STAT ‘…New obesity drugs are seemingly everywhere. Black Americans feel left out.’
Many Black Americans, including patients and medical experts, worry that their community is being left behind.
Non-Hispanic Black adults have the highest rates of obesity, at nearly 50%, though Black people with diabetes are less likely to be prescribed GLP-1 drugs.
Fatima Cody Stanford, at Massachusetts General Hospital, thinks ‘…the conversation is definitely missing the Black community.’
She adds that for Black folks living with obesity, not only do they continue to face weight bias, but they also face racial bias.
DATA
From Nature Medicine, semaglutide lowered rate of long-term kidney outcomes by 22%, compared to placebo, at four years.
These results suggest a benefit of semaglutide on kidney outcomes in individuals with overweight/obesity, without diabetes, with direct kidney protective effects.
This data comes from the same SELECT trial that demonstrated that once-weekly subcutaneous semaglutide 2.4 mg was associated with a 20% reduction in major adverse cardiovascular events (MACE) versus placebo.
Whilst this data is certainly impressive and meaningful, from a real numbers perspective, there were 43 patients in the semaglutide who avoided the long-term kidney outcomes… from a total sample size of over 8,800 patients on semaglutide in the clinical trial.
We would have to treat just over 200 patients on semaglutide, to impact a single patient with respect to improve their outcome of kidney disease.
This leads to an economic analysis that I am sure is in process, to reflect on the cost of treating 200 patients over four years, on semaglutide, in comparison to the cost savings of avoiding kidney dialysis and/or kidney transplantation.
Blue Health Intelligence, a data analytics and software company, undertook an evaluation of almost 170,000 unique GLP-1 users for weight loss, notes less than half of those prescribed stay on the medication for 12 weeks or more.
Younger adults were less likely to continue the drug, whereas those who were prescribed the medication by an endocrinologist or obesity medicine specialist were more likely to continue for longer.
Indeed, this data states 30% of patients dropped out of treatment after the first four weeks, and 58% at 12 weeks.
Those who dropped out are unlikely to achieve clinically meaningful weight loss.
The likelihood of continuance was further exacerbated for those with health inequities or who lived in underserved health regions.
The data comes from Blue Cross Blue Shield members participating in Plans that provided coverage of these products, from 2014 through to end of 2023.
Razia Hashmi, vice president for clinical affairs at Blue Cross Blue Shield wants to ‘…paint a clearer picture of what makes somebody successful.’
The missing piece here is why the patients stopped – side effects, failure to achieve initial weight loss, stigma and discrimination, or coverage issues related to cost and access.
My longtime friend, colleague and bariatric surgeon at Stanford University, Dr. Dan Azagury rightly states ‘…The goal is for patients to stay on this for a significant amount of time. Most likely… beyond 12 weeks.’
The SURMOUNT-CN trial of Tirzepatide for Weight Reduction in Chinese Adults With Obesity reported this week in JAMA.
Chinese adults with BMI over 28, or over 24 with one weight-related co-morbidity, experienced 17.5% total weight loss, with 15mg tirzetapide at week 52.
85% of subjects achieved at least 5% total weight reduction, though an impressive 29% did so on the placebo drug.
Whilst the study only recruited 210 subjects in total, compared to many thousands for the other published studies, the results are of importance in the population for Chinese adults, and with lower BMIs.
Indeed, Chinese people account for the largest number of individuals living with obesity and overweight worldwide, with implications for the global obesity epidemic.
A cursory search does not lead me to find similar trials in process in China or India, that I am sure must be under investigation.
