Wegovy and other new weight loss drugs work, what next?

Few prescription drugs have entered the public consciousness as suddenly as Ozempic and Wegovy have in recent years. Novo Nordisk’s brand-name drugs have become as synonymous with weight loss as Viagra and Cialis are with erectile dysfunction. But while 2023 has made it clear that these and similar drugs really are the future of obesity treatment, it’s also shown that that future can sometimes look very confusing for reasons that have little to do with the drugs themselves.

Semaglutide: The Real Deal

Semaglutide is the active ingredient in both Ozempic and Wegovy, which are given weekly by subcutaneous injection. Its a synthetic and longer-lasting version of the GLP-1a hormone, which regulates hunger and metabolic functions such as insulin production. The Food and Drug Administration approved Ozempic for the treatment of type 2 diabetes in 2017; in 2021, a higher dose of Wegovy was approved for the treatment of obesity.

Wegovy demonstrated unprecedented success in clinical trials leading to its FDA approval, helping people lose an average of 15% of their baseline body weight. With these results, many experts predicted a a new era of obesity medicine. And in the data collected since then, semaglutide is not just works as expected but appears to offer benefits beyond weight loss, such as alleviating some of the symptoms of addiction.

In November, researchers published a case series of people with alcohol use disorders who started wanting to drink less when they started using semaglutide to treat obesity. Several groups are currently conducting drug trials for alcohol addiction and other compulsive disorders, such as binge eating disorder. Elsewhere, researchers have begun to investigate whether GLP-1s can reduce brain inflammation and slow the progression of diseases such as Alzheimer’s. promising results early on.

There may be other health benefits. This summer Novo Nordisk exempt Results of the SELECT trial, which looked at obese or overweight people with a history of cardiovascular disease who received high doses of semaglutide or placebo. Compared to placebo, those who received the drug had a 20% lower risk of serious (and potentially fatal) cardiovascular events such as heart attack or stroke for up to five years. In October, the company decided stopping a similar trial of semaglutide in chronic kidney disease early after preliminary results found a clear benefit.

This reduction in risk is likely due in large part to weight loss, which is an important finding in itself. Many studies have shown that weight loss can improve the overall health of obese people, but this has been difficult to demonstrate directly because people usually struggle to lose and keep off significant weight long enough to study them, outside of procedures like surgery. . But some studies have suggested that these benefits are not due to weight loss alone and may be related to other effects of semaglutide in the body.

Not all of these research opportunities may pay off. But even if only a few do, these drugs could heal and potentially save the lives of millions of people more than anyone originally imagined.

The competitor enters the ring: Tirzepatide

Perhaps the most important development this year was the FDA adoption Eli Lillys Zepbound for obesity in November. The drug’s active ingredient is tircepatide, which mimics both GLP-1 and another combination of hunger-related hormones GIPa, which appears to be even more effective in treating obesity than Wegovy. In clinical trials, people receiving tircepatide have lost an average of 20-25% of their baseline weight, a level of weight loss close to the results seen in the most successful bariatric surgeries.

The arrival of Zepbounds not only adds to the fierce competition in the obesity drug market, but suggests that these products are just the beginning. Now there are dozens of them other obesity drug candidates with preparations, some of which may help people lose weight more than either semaglutide or tircepatide, or may offer other benefits, such as being easier to take through the pill rather than by injection.

No Free Lunch: Side Effects of Weight Loss Drugs

As almost miraculous as these drugs seem, few medical treatments are risk-free. People who use them often have gastrointestinal problems such as vomiting and diarrhea. These symptoms usually go away over time and are usually not severe enough for most people to stop treatment. But there has also been some indication that people can develop serious complications such as gastroparesis (stomach paralysis), pancreatitis and even suicidal thoughts. In September, the FDA updated its Wegovy and Ozempic labels warning that the products could potentially cause ileus (intestinal blockage) based on adverse event reporting data, although the agency did not confirm this as a known risk.

Some of these suspected side effects, such as suicidal thoughts, have less evidence currently supporting link to the use of GLP-1 than others. And in general, serious problems like gastric paralysis and ileus seem to be rare. But doctors and patients must remain aware of these issues and evaluate whether the benefits are worth facing these risks.

Semaglutide Off-Label and Black Market

Not all complications associated with these drugs are medical. Production problems and unexpected demand have led to ongoing shortages of both Wegovy and Ozempic, as many doctors have started prescribing the latter drug for weight loss. This, in turn, has affected the care of people who take Ozempic as intended, with diabetes patients let’s change to other, possibly less effective drugs.

The overwhelming supply of these drugs, high list prices (over $1,000 per month without insurance) and the usual lack of insurance coverage have also contributed to the emergence of the drugs. gray and black markets. People now buy custom-made and much cheaper semaglutide from compounding pharmacies, although there are no guarantees that it is safe or effective. The growing popularity of semaglutide may also increase overdoses. Earlier this month, Americas Poison Centers reported that around 3,000 drug-related calls have been made to poison control centers nationwide this year, which is 15 times more than in 2019. In other countries, such as Austria, counterfeit semaglutide has started to circulate, and some people have already ended up in the hospital taking mislabeled products that actually contain insulin.

The road ahead

Recent clinical data suggests that many people do regain some of the lost weight if they stop taking these medicines. That’s not inherently a problem because many chronic conditions require ongoing care, but it complicates things. Will people be able to pay for, say, these drugs, especially since insurance companies have started to limit their coverage? What happens to the health of people who lose weight and gain it back as a result of losing coverage, as weight cycling is generally thought to be harmful?

Barring the discovery of a dangerous and relatively common side effect, it is unlikely that these drugs will become less popular anytime soon. But even in a world where these drugs are generally safe and effective, not everyone is going to be a fan of them.

Some critics are argued that these drugs do little to help most obese people and perpetuate harmful messages about obesity, such as the idea that people need to be thin to be healthy. On the contrary, you don’t have to scroll too far through social media posts about drugs to find people who like them quick fix and saying that people should lose weight the real way, just through lifestyle changes, as if people weren’t consuming billions of dollars annually in vain to try to do so.

Others argue that these drugs do not address the factors behind obesity, such as barriers to access to nutritious and fresh foods. But then neither are statins for cardiovascular disease or chemotherapy for colon cancer for other chronic diseases that are also associated with a less healthy diet or lack of exercise.

It’s true that drugs like semaglutide and tircepatide won’t solve obesity on their own (assuming you believe it should). But they do and continue to help some people lose weight and possibly become healthier overalls as long as you can afford to pay or find safe products. It is not so easy to predict anything beyond this, including their impact on society in general.

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