As long as the so-called diseases of affluence have existed, there have also been drug treatments for most of them. Whether they are desirable, elegant, sufficient or morally-philosophically defensible are different questions. But statins lower cholesterol, metformin helps against diabetes, lisinopril works great for high blood pressure, pantoprazole for heartburn, puffers for COPD and venlafaxine for mood swings. There is no shortage of symptom-fighting agents in the pharmacy, Our Lord and Pharma are praised. However, no adequate cure has been available for obesity in all that time.
Until this year. 2021 marks a turning point in the treatment of the disease obesity, as there is a drug treatment that results in a lot of body fat loss. An unprecedented result, until now only achievable by strict lines or with a surgical procedure. There is excitement in the circles of obesity practitioners. Every kilogram of body weight lost provides health benefits for obese people. A drug treatment that results in kilograms of relief without serious side effects is nothing less than a sensation in the light of all these years of fruitless research.
A drug treatment that results in kilograms of relief without serious side effects is nothing less than a sensation in the light of all these years of fruitless research.
There has been regular news about this over the past year semaglutide, a drug that has been used successfully against diabetes for some time, but also causes significant weight loss in higher doses.
In March, a group led by British and American researchers published in the journal NEJM the results of a double-blind trial, a study design that provides high-quality evidence. Nearly 2,000 obese individuals from 16 countries around the world were given medicine, diet and exercise coaching for 68 weeks (which is a long time for such trials). Diet and exercise were the same for all participants, but half received a placebo and the other half an injection of 2.4 mg semaglutide every week. In the semaglutide arm a mean weight loss of 14.9% was measured (with significant outliers to both sides), in the placebo group 2.4%, a significant difference. This result was hailed worldwide as a ‘game changer’ in the treatment of obesity.
De European Medicines Agency (EMA) had already approved semaglutide as a diabetes drug (maximum dose of 1 mg/week) and, apart from short-term diarrhea and nausea, 1 in 10 users noted no objections. Even at this dose weight loss is already observed in some.
However, one swallow does not make a summer. In addition, the successful trial was funded by NovoNordisk, the manufacturer of semaglutide, which is sold under the brand names Rybelsus (tablets) and Ozempic (injections). Such sponsored research can always count on skepticism. But semaglutide is now widely used by healthcare providers, after it was approved by the US drug authority FDA in June of this year as a drug against obesity (in the high dose).
Another swallow is the similar liraglutide, sold as a diabetes drug under the brand names Victoza and Saxenda, also from NovoNordisk. In November published Belgian researchers presented the results of a single-centre retrospective cohort study with 115 patients treated with liraglutide between 2016 and 2020. The average weight loss was 9.2%, which is significant. Treatment also included lifestyle improvements and in some cases additional medication, including metformin, which is widely used in diabetes. That combination of drugs turned out to be even more effective.
Since August of this year a new swallow has appeared in the sky: tirzepatide
German researchers came up with a Overview of developments in anti-obesity drugs. In the past century, all kinds of medicines and preparations have been used, such as amphetamine and (animal) thyroid hormones. It often turned out that approved medicines had to be banned again after a while because of serious side effects, such as: rimonabant. Rarely did the achieved result exceed a few percent weight loss.
Only after the molecular mechanisms behind the regulation of hunger, glucose metabolism and fat storage had been mapped, and partly due to the discovery of the satiety hormone leptin in 1995, it became clear in which direction to look for an active molecule: a GLP-1 agonist.
The EMA explains how that works in the description from Ozempic/semaglutide: “The active substance in Ozempic, semaglutide, is a ‘GLP-1 receptor agonist’. It works in the same way as GLP-1 (a hormone produced in the gut) by increasing the amount of insulin that the pancreas in response to food, which helps control blood sugar.”
Since August of this year, a new swallow has appeared in the sky: tirzepatide. Also a GLP-1 agonist, but produced by another pharmaceutical company, Eli Lilly. This drug has also been designed and is being tested as a diabetes medicine. The first research results are above expectations for glucose-regulating activity.
But tirzepatide also appears to be more effective and more effective in causing weight loss than semaglutide, according to a comparative study. study. Due to the slightly different effect of tirzepatide, hypoglycaemia, which is a drop in blood sugar, is less common than with semaglutide, but side effects such as nausea are slightly more common.
Eli Lilly expected to request approval for their drug from the FDA this year, but first as a diabetes drug. It may then take a few more years before it is also approved as an anti-obesity drug, according to the blog Conscient Health.
Approval by the authorities is crucial, followed by the usual battle between pharmaceutical companies, doctors, patient associations and insurers to make the drug widely and affordably available to the ever-increasing number of obese patients.
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Losing more than 9% with a simple pill – Obesity drugs are gaining momentum due to semaglutide – Foodlog