Roche acquires GLP-1 Company; New York’s Bellevue Hospital in the Limelight; Just 40% still on Ozempic after One Year; 50% Lower Risk of Colon Cancer for those on GLP-1 Meds!
Roche is ‘…acquiring Carmot Therapeutics and the company’s line of weight loss drug candidates for $2.7 billion upfront…’ in a news story from STAT.
‘Zepbound is now available at pharmacies across the U.S.…’ with a ‘…commercial savings card program…’ as per CNBC.
Fast Company relays large employers have focused upon halting coverage for their employees to access GLP-1 medications; which is ‘…where eight-year-old healthcare technology company Virta sees an opportunity.’
A high-profile story in The New York Times covers New York’s Bellevue Hospital performing up to three thousand bariatric surgeries a year.
A cohort study of over 12,000 pregnancies in Swedenreported that ‘…Pregnancy weight gain is lower in women with a history of bariatric surgery compared with those without.’
Dr. Hamlet Gasoyan and colleagues at the Cleveland Clinic sought toreview patients with an initial antiobesity medication (AOM) fill, and find one-year persistence of semaglutide, commonly known as Ozempic or Wegovy, was a mere 40%, and closer to 15% for older medications such as phentermine.
From research in JAMA Oncology, of over 1.2 million patients with type 2 diabetes, those on GLP-1 anti-obesity medication had a 50% lower risk of colorectal cancer, compared to those on insulin alone.
NEWS
Roche, a 127 year-old Swiss-based pharmaceutical giant with over 100,000 employees, is ‘…acquiring Carmot Therapeutics and the company’s line of weight loss drug candidates for $2.7 billion upfront…’ in a news story from STAT reporter Andrew Joseph.
Carmot, based in Berkeley, California, has ‘…three experimental obesity medicines… in Phase 1 or Phase 2 testing…’ targeting GLP-1 receptors.
The scientific advisory board at Carmot Therapeutics boasts luminaries in the obesity and metabolic care field such as Dr. Carel le Roux, Dr. Ildiko Lingvay and Dr. Donna Ryan; the biotechnology focus is upon injectable peptide drugs, and an oral small molecule candidate too.
In the past year, we have seen Eli Lilly and Novo Nordisk make early stage bets – this news from Roche is likely to put greater fuel to the fire on early stage GLP-1 developments, and their acquisition by big pharma.
The European Medicines Agency will ‘…request more data from makers of a class of diabetes and weight-loss drugs including Novo Nordisk’s popular therapies Ozempic and Wegovy to further investigate suicidal thoughts in some patients taking them…’ from Reuters.
The EMA had ‘…initially received reports from the Icelandic Medicines Agency, based on two cases involving liraglutide, the active ingredient in Saxenda, and one case for semaglutide, the active ingredient in Ozempic and Wegovy.’
Indeed, further review was ‘…based on at least 170 case reports from EudraVigilance, a system to register suspected adverse reactions to medicines.’
This investigation is likely to continue over many months – and likely without a definitive outcome.
‘Zepbound is now available at pharmacies across the U.S.…’ with a ‘…commercial savings card program…’ as per CNBC.
Whilst a first step, Rhonda Pacheco, Eli Lilly’s group vice president for diabetes and obesitysaid they ‘…have to work hand-in-hand with employers, government and healthcare industry partners to remove barriers and make Zepbound available to those who need it.’
Heather Landi at Fierce Healthcare publishes on six-year-old telehealth giant Hims & Hers and its ‘…much anticipated weight loss program this week.’
Craig Primack, M.D. Hims & Hers’ new senior vice president of weight management and a past obesity medicine physician, said GLP-1 meds were ‘…on our radar to bring in when we can control the price and control the supply chain…’ though the offering will initially include older anti-obesity medications such as bupropion and naltrexone.
The ‘…more affordable approach to reducing weight…’ employs in the main nutrition, behavior, movement, and medical treatment.
Primack relayed ‘…a personalized approach using our pharmacy technologies to give people different options.’
OPINION
Fast Company relays the notion that large employers such as the University of Texas and Ascension health system have focused upon halting coverage for their employees to access GLP-1 medications; which is ‘…where eight-year-old healthcare technology company Virta sees an opportunity.’
Virta Health assures patients with their winning formula to reverse type 2 diabetes, without meds and a focus upon nutritional therapy.
CEO Sami Ikinen says in ‘…the last 18 months, we went from exclusive focus on type 2 diabetes to treating people who are obese or overweight…’ with an additional focus to ‘…weaning patients off GLP-1s.’
Ikinen reportedly states that ‘…70% of Virta patients came off GLP-1s within a year…’ though does not report on outcomes per se of this group – which of course is the litmus test here.
GLP-1 medications ‘…offer the first real chance to deploy at scale treatments to halt a seemingly unstoppable trend…’ of obesity in over 100 million Americans, and though ‘…That will be costly… so is the status quo…’ from Jeremy Shane writing at STAT.
In terms of Medicare, ‘…Beneficiaries with two or more of the costliest conditions – diabetes, heart failure, or chronic kidney disease – comprise just 10% of beneficiaries… [but] account for 25% of total costs.
Those with all three conditions are 2% of beneficiaries but almost 7% of costs.’
But and rightly said, ‘…if our goal is to stop Americans from reaching Medicare with diabetes and obesity, these drugs are currently our best bet…’ with an important caveat that a multimodal approach, inclusive of lifestyle and/or bariatric surgery should be strongly advocated and considered.
A model for ‘…design pricing tied to patient outcomes with payments to pharmas spread out over many years…’ is desirable, though unlikely, simply in the current state of mismatched supply and demand issues, at current pricing.
I do like the risk sharing approach to GLP-1 medication therapy, though it will only work if developed and delivered by an independent third party, an honest broker of sorts, rather than by either or of the pharma company or the insurance agency.
Whilst a possibility for Medicare, most insurers only maintain their beneficiaries for one to two years – making them an unlikely candidate to pay upfront, and then for Medicare to garner the downstream value.
A headline figure of $100B predominates for market size of anti-obesity medications by 2030 – from Goldman Sachs, Barclays, BMO Capital Markets and Pfizer, in discussions by analysts at STAT in NYC: A Look Ahead at Biotech in 2024.
But will competition ‘…eventually drive down prices…’ or will ‘…insurers and particularly Medicaid could negotiate lower prices or otherwise restrict access.’
That is why they are called projections!
A high-profile story in The New York Times, sent to me by numerous folks in my network, covers New York’s Bellevue Hospital performing up to three thousand bariatric surgeries a year.
The NYT investigation ‘…found that the bariatric program, led by surgeons with financial incentives to perform more operations, has become a high-speed assembly line…’ which ‘…frequently cuts corners as it hustles patients through the process.’
Of concern, ‘…the hospital has operated on people whose body mass indexes were too low for them to qualify for surgery…’ and has ‘…recruited patients from New York City’s Rikers Island jail complex who have virtually no chance of maintaining the required diets after surgery.’
Dr. Carmen Kloer, a Bellevue medical resident was quoted in reference to the bariatric surgeons that ‘…They are just churning through cases.’
The article notes ‘…Weight-loss surgeries now account for one of every five operations at Bellevue…’ and has ‘…crowded out other services, with the hospital repeatedly delaying urgent surgeries for patients with stab wounds and broken bones.’
Christopher Miller, a spokesman for Bellevue, referred to ‘…an incredible need and demand for this surgery…’ which is ratified by the fact that less than 1% of eligible patients across the U.S. undergo bariatric surgery.
He also ‘…denied that Bellevue operated on unqualified patients or that it rushed them through screening and approval.’
In counter, Miler said they had worked to make ‘…its surgical processes more organized and efficient.’
Melody Vargas, a Bellevue bariatric surgery patient in 2016, described the process as ‘…crowded and rushed…’ while the article details her complications from surgery, and those of others too.
From a clinical and academic perspective, it is important to note that to accurately evaluate a bariatric surgery program, data must be reviewed across a multi-year period – from the perspective of complications, readmissions, outcomes, and processes both before and after surgery.
The American Society of Bariatric and Metabolic Surgery works to accredit over 900 sites of bariatric surgical care across the country, known as the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, or MBSAQIP, in accordance with nationally recognized bariatric surgical standards.
The MBSAQIP is in place to make a just evaluation of all bariatric programs across the U.S., in the same vein that cancer and trauma programs are scrutinized for quality across the country.
DATA
A cohort study of over 12,000 pregnancies in Sweden reported that ‘…Pregnancy weight gain is lower in women with a history of bariatric surgery compared with those without.’
Indeed, a BMI of 30 or higher is ‘…a risk for adverse maternal and fetal outcomes…’ and a lower weight gain during pregnancy can help to avoid the complications of gestational diabetes to both the mother and child.
Dr. Hamlet Gasoyan and colleagues at the Cleveland Clinic sought to review patients with an initial antiobesity medication (AOM) fill, and characterize factors associated with persistence at 12 months, in Obesity, a research journal.
From just shy of 2,000 patients, one-year persistence of semaglutide, commonly known as Ozempic or Wegovy, was a mere 40%, and closer to 15% for older medications such as phentermine.
Commercial insurance carrier was also implicated, in that it had an impact upon percentage of persistence.
I do think this type of data, in addition to a past publication from Prime Therapeutics, will drive greater scrutiny on the adherence and impact of GLP-1 medications, in a move from the results in tightly controlled clinical studies, toward real world analyses, at the level of individuals and populations.
From a research letter in JAMA Oncology, over 1.2 million patients with type 2 diabetes were evaluated during a 15-year period, with respect to a diagnosis of colorectal cancer – known to be associated with obesity as a risk factor.
In patients suffering from overweight and obesity, those on GLP-1 anti-obesity medication had a 50% lower risk of colorectal cancer, compared to those on insulin alone.
This type of data mirrors the knowledge we have for over two decades from long-term studies of patients having undergone bariatric surgery – there is overall a one-third lower risk of breast, prostate, and colon cancers over a ten-year period.
I am certainly excited by this early research, and look forward to additional studies to corroborate the preliminary findings.
