Eli Lilly reports Tirzepatide reduced sleep apnea severity by up to nearly two-thirds in adults with obstructive sleep apnea (OSA) and obesity.
Karen Kaplan at the Los Angeles Times rightly notes ‘…doctors who treat obesity… fear the medications are making this health disparity worse.’
Is the Era of ‘Brozempic’ Upon Us? asks The New York Times, with reports of some telehealth start-ups ‘…playing up masculine stereotypes…’
Rita Rubin at JAMA asks if GLP-1 Receptor Agonists like Semaglutide Treat Addiction, Alzheimer Disease, and Other Conditions?
Nature has a feature on ‘Obesity drugs aren’t always forever.’
NEWS
Eli Lilly reports Tirzepatide reduced sleep apnea severity by up to nearly two-thirds in adults with obstructive sleep apnea (OSA) and obesity.
The phase 3 clinical trials that showed tirzepatide injection significantly reduced the apnea-hypopnea index (AHI) compared to placebo; AHI is a measure of a person’s breathing with a restricted or complete block of airflow per hour of sleep, and directs the degree of severity of OSA.
In adults with moderate-to-severe OSA and obesity who were not on positive airway pressure (PAP) therapy for 52 weeks, tirzepatide led to a mean AHI reduction from baseline of 27.4 events per hour, compared 4.8 events per hour for placebo, or a 55% versus 5% reduction.
This was associated with a mean body weight reduction of 18.1% for those on the drug, compared to 1.3% for placebo.
Similar results were achieved on adults with moderate-to-severe OSA and obesity who were on and planned to continue to use PAP therapy for 52 weeks.
Of note, OSA is very common in people with obesity, impacting up to 80 million adults in the U.S., with more than 20 million living with moderate-to-severe OSA.
So here we have an additional indication that Eli Lilly has will submit to the FDA on Fast Track designation for the treatment of moderate-to-severe OSA and obesity.
We have just seen Novo Nordisk garner FDA approval for its obesity drug Wegovy to be used to prevent cardiovascular complications and is seeking FDA approval treat heart failure.
The times they are a changing…!
OPINION
Game-changers, a gift, and Breakthrough of the Year – in reference to GLP-1 medications.
Really?
Karen Kaplan at the Los Angeles Times rightly notes ‘…doctors who treat obesity… fear the medications are making this health disparity worse.’
Black and Latino Americans, low-economic status individuals, and women are affected in a triple whammy – they are more likely to be affected by obesity, they are less likely to seek treatment for obesity, and when they do, their outcomes are inferior to those of a Caucasian male.
Dr. Lauren Eberly, a cardiologist at my past place of work, the University of Pennsylvania says ‘…I feel like if a group of patients has a disproportionate burden, they should have increased access to these medicines…’ which is sadly not the case.
Dr. Serena Jingchuan Guo at the University of Florida found the ‘…disparity was greatest in places with the highest overall usage of the medications, including New York, Silicon Valley, and south Florida.
In those places, the drug is actually widening the gap.’
Dr. Hamlet Gasoyan, the Cleveland Clinic’s Center for Value-Based Care Research has spent many years documenting racial disparities in the use of effective treatments for obesity, such as bariatric surgery.
He adds ‘…Newer drugs such as Ozempic simply bring the problem into sharper focus.’
Yes, but this focus necessitates action, not just the description of the state.
Is the Era of ‘Brozempic’ Upon Us? asks The New York Times, with reports of some telehealth start-ups ‘…playing up masculine stereotypes to market medications.’
Fella Health, a telehealth start-up, promotes images of a grinning golfer with a modest belly, a silver fox in a suit jacket, and a bearded father, to market the drugs to men, particularly middle-aged men.
The article notes ‘…Fella says it prescribes semaglutide – the active ingredient in Ozempic – from compounding pharmacies…’ akin to its much larger competitor Ro.
Indeed, in my bariatric surgical practice, the overwhelming majority of patients were female; it is high time we focused upon treatment of men too, in the quest to eradicate obesity – though not just with GLP-1 meds, but rather with a multimodal approach to care.
Jonathan Isaacsohn, a cardiologist and past chief medical officer at Teva Pharmaceuticals, wants to move the conversation about obesity beyond the scale.
He writes in STAT on ‘…the provocative nature of the discourse on obesity and highlights the societal shift in addressing obesity.’
The public’s acceptance of obesity as a disease rather than a lifestyle choice, the shift from viewing obesity as a personal fault to seeing it as a disease that is sometimes best served by treatment with a medication validates its clinical nature as a chronic disease.
The cardiologist wants to focus the reader on ‘…a weight loss approach that prioritizes preserving lean mass and energy expenditure…’ for ‘…durable, sustainable, quality weight reduction as well as long-term health and metabolic stability.’
Rita Rubin at JAMA asks if GLP-1 Receptor Agonists like Semaglutide Treat Addiction, Alzheimer Disease, and Other Conditions?
Quitting smoking, targeting alcohol use disorder, cocaine use disorder, chronic kidney disease and Alzheimer’s and Parkinson disease are all considered – the overall answer is yes, maybe.
We definitely need more data on clinical trials, but the overwhelming approach is that we should be cautious before being too rampant in considering GLP-1 medications as a wonder drug for all maladies of civilization.
The journal Nature has a feature on ‘Obesity drugs aren’t always forever. What happens when you quit?’
Indeed, about two-thirds of patients in the United States who started taking a GLP-1 drug, in 2021 had stopped using them within a year, according to an industry analysis.
So, what of these meds as lifelong treatments – side effects, access to the drug, and cost are all pertinent issues. when people stop taking GLP-1 agonists, many regain a substantial amount of what they lost; the body naturally tries to stay around its own weight point – this is ‘…a pull that obesity specialist Arya Sharma likens to a taut rubber band.’
From a semaglutide trial, subjects who lost an average of 17.3% of their body weight after one year on the drug, regained about two-thirds of that lost weight after one year without any clinical-trial interventions.
The improvements in heart disease and metabolic health also revert, measured as blood pressure, cholesterol, and glucose levels.
Importantly, ‘…not everyone responds to GLP-1 agonists…’ with nearly 14% of participants losing less than 5% of total body weight after more than one year of taking semaglutide.
Dr. Fatima Cody Stanford adds that another ‘…option might be bariatric surgery.’
DATA
UK-based researchers state ‘Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society…’ in The Lancet Regional Health Europe.
In addition, ‘…Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating.’
The Avon Longitudinal Study of Parents and Children or ALSPAC, explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, on over 4,000 individuals.
IWS was higher for females, sexual minorities, and less socioeconomically advantaged individuals, and for participants whose mothers had minimum or no qualifications.
IWS was also higher for people who at age 13 years felt pressure to lose weight from family, and the media, or had experienced bullying.
Whilst much of this information is already known, there may be fruitful targets for intervention to reduce IWS and its consequences.
Dr. Louis Aronne at Weill Cornell Medical College in New York City, on behalf of the SURMOUNT-4 investigators studying GLP-1/GIP drug tirzetapide, responds in JAMA to questions on risk of thyroid cancer, gastrointestinal side effects, the role of lifestyle interventions, risk of use females who are unknowingly pregnant, and long-term effects.
ADDITIONAL TOPICS
On LinkedIn, Dr. Michelle Gourdine, Health and Chief Medical Officer at CVS Caremark writes How does health equity fit into the GLP-1 conversation?
Dr. Ezekiel Emanuel, writes in the New England Journal of Medicine on Fair Allocation of GLP-1 and Dual GLP-1–GIP Receptor Agonists.
The Wall Street Journal warns on Influencers Love Ozempic—but They Aren’t Telling You About the Risks.
Lisa Rapaport at Everyday Health asks What Is Food Noise and How Do You Get Rid of It?
