Roche’s New Oral GLP-1 Med; Closure of Oklahoma Bariatric Surgery Clinic; Personalized Nutrition; Sleep Apnea and GLP-1s; 15 Years Later, Bariatric Surgery Works.

AT A GLANCE


NEWS

  • Bloomberg write on EU cites anesthesia risks for weight-loss and diabetes drugs.
    • They state ‘…The safety committee of the European Medicines Agency advised patients treated with GLP-1 drugs to inform their doctor before undergoing surgeries with general anesthesia or deep sedation.’
    • This is due to a risk of aspiration of stomach contents for patients under anesthesia and taking such medication, from delayed stomach emptying as a functional mechanism of GLP-1 medications.
    • Stateside, ‘…The American Society of Anesthesiologists also issued guidance in June 2023 to suggest patients skip a dose of the drugs prior to surgery.’
  • STAT reports on Roche’s new data on an early-stage obesity drug CT-388, from its acquisition of Carmot Therapeutics.
    • The take home message is that those ‘…on the highest dose did not yet reach a plateau at the end of the trial…’ at 24 weeks, having achieved 18.8% total weight loss.
    • The drug does not expect to launch until 2029, giving duopoly laderrs Eli Lily and Novo Nordisk ample time to study next-generation candidates in late-stage studies.
  • Roche announced its once-daily pill, CT-996, led to a placebo-adjusted average weight loss of 6.1% after four weeks in patients with obesity who did not have diabetes, as per STAT.
    • The obesity pill hype lifted Roche shares by 5% in early trading.
    • Chief medical officer Levi Garraway was ‘…pleased to see the clinically meaningful weight loss in people treated with our oral GLP-1 therapy CT-996…’, the drug candidate acquired through the $2.7B purchase of Carmot Therapeutics earlier this year.
  • The Oklahoman reports ‘…Norman Regional Health System is blaming the diabetes management drug and similar medications, which have soared in popularity because of its effectiveness in helping people lose weight, for the decision to suddenly close its Journey Clinic.
    • Journey Clinic has offered medical and surgical weight loss options for the past two decades, will close in 90 days and is not accepting any new patients.
    • In the past year, weight loss surgeries have fallen by 30%.
    • Norman Regional’s CEO Richie Splitt said ‘…We’ve been seeing that decline in volumes over time, which led us to have some very frank conversations and then ultimately to the difficult decision to close the Journey Clinic and bariatric operations.’
    • Lana Nelson, director of metabolic and bariatric surgery at Norman Regional noted ‘…that even with the widespread use of cholesterol and heart-health drugs on the market, there’s still persistent demand for cardiac surgery.’
    • And further ‘…Medications will not stop the need for bariatric surgery. Not anytime soon.’
    • Nelson states ‘…this was purely a financial decision to abandon a program that has been serving the Norman comm

OPINION

  • The team at Rock Health, together with real-world data company Evidation, undertook a survey to ‘…better understand the weight care experiences and preferences of U.S. adults who are overweight or obese.’
    • From an initial cohort of 150,00 respondents, 10,000 were reported upon, i.e. regard to approaches to weight loss, access to treatment modalities, barriers to receiving GLP-1 meds, combined approaches to weight loss, and desired weight care support.
    • Almost all respondents were or had utilized exercise [88%] or diet [84%] as a weight loss modality, with just 11% for GLP-1 medications, and 4% for bariatric surgery.
    • Virtual coaching companies of high usage were NOOM, WeightWatchers and Omada; NOOM, WeightWatchers and Alpha were the most utilized among those that had been prescribed GLP-1 medications.
    • Despite their extensive marketing approaches, I was surprised to see Ro at just 3% of the GLP-1 coaching companies, and Hims and Hers not even on this list.
    • Whilst this data is informative rather than prescriptive, I do agree with the authors that ‘…Weight care is not one-size-fits-all. Effective solutions must be adaptable to diverse preferences while promoting sustained engagement amongst consumers.’
  • Precision medicine, which aims for a tailored approach to health care, has long been a popular concept and target.
    • The Lancet Diabetes & Endocrinology reviews the concept of personalized nutrition, such that ‘…the specific physiological response of an individual to certain food ingredients is determined by genetic background, gut microbiome, and lifestyle factors, as well as phenotypic factors such as age and sex.’
    • This is supported by monitoring technologies, such as faecal sampling kits, blood tests, and a growing trend to use continuous glucose monitoring (CGM), in people without diabetes.
    • Even though metabolic health encompasses more than blood sugar levels, ‘…due to the availability of glucose readings, personalized nutrition relies heavily on a few biomarkers, such as glucose and microbiomics, which risks skewing the general public’s perception.’
    • The article closes with a warning to ensure evidence-based claims, and to avoid ‘…not only the exploitation of consumers, but also to prevent a flawed view of metabolic health.’
    • So is precision nutrition a step too far?
  • Peter Loftus at The Wall Street Journal writes The New Holy Grail for Weight-Loss Drugs Is Sleep Apnea.
    • Damon Sedgwick from Sydney was enrolled in a trial of Eli Lilly drug tirzetapide to evaluate its effect on patients with sleep apnea; after just one year, Sedgwick had lost more than 70 pounds and showed no signs of sleep apnea at the final overnight clinic visit.
    • Derek Asay, SVP of Government Strategy at Eli Lilly is quoted ‘…It helps give that reason to believe there’s more than weight loss here.’
    • In the clinical trial of nearly 470 patients in two Eli Lilly studies, Zepbound reduced the severity of sleep apnea by more than 60% compared with a placebo; Eli Lilly has applied to the FDA to approve Zepbound’s use to treat sleep apnea.

DATA

  • The Lancet eClinicalMedicine published on over sixty thousand patients prescribed semaglutide, from the TriNetX US Collaborative Network, covering >100 million patients in the USA.
    • All patients had a diagnosis of type 2 diabetes, and were on anti-diabetic medication too.
    • Semaglutide, also known as Ozempic and Wegovy, was associated with a 28% reduced risk of cognitive deficit, 48% lower rate of dementia, and 18%-28% reduction in nicotine misuse.
    • The authors note potential beneficial associations of semaglutide with cognitive deficit and nicotine misuse, that warrant validation in clinical trials.
    • This is observational rather than controlled research; Novo Nordisk is already conducting two phase 3 studies, EVOKE and EVOKE+, on the role of semaglutide and cognitive function in patients with early Alzheimer’s disease.
  • From over two thousand patients having undergone bariatric surgery in Sweden, at 15 year follow-up there were ‘…greater improvements in perceived health and overall mood, and greater reductions in depression, obesity-related problems, and social interaction limitations than controls.’
    • The publication in the International Journal of Obesity is commented upon by Ted Kyle at ConscienHealth, in that ‘…Life Is Better 15 years After Metabolic Surgery.’  

DR.RAJESH TWENTLY 30 HEALTH


ADDITIONAL TOPICS

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