ObesityWeek Roundup: Patients May Have Weight Loss Drugs

SAN ANTONIO – Research presented at the annual ObesityWeek conference included studies of prescription drug dosage among obese adults, the effects of weight loss with 25 mg of semaglutide of oral, and blood pressure risk reduction in adolescents taking GLP-1 receptor agonists.

Obese Adults More Likely to Turn to Drugs to Save Money

Obese adults are more likely to pass on prescription drugs to save money compared to non-obese adults, according to an analysis of research data from government.

The prevalence of drug use related to costs was 8.3% among adults with obesity versus 5.9% among non-obese (Q<0.001), reports Alissa S. Chen, MD, MPH, of the Yale School of Medicine in New Haven, Connecticut. The findings are also published in the research paper on JAMA Network Open.

In addition, adults with obesity and cardiovascular disease (CVD) had a higher rate of obesity than those without CVD (10.3% vs 8%), Q=0.005).

About 80 percent of adults find the cost of prescription drugs unreasonable, and the high cost of GLP-1 receptor agonists can exacerbate existing prescription painkillers. doctor as not all insurers cover them, Chen said. Physician assignment has important implications for health equity as a higher proportion of Hispanic (50%) and Hispanic (45%) adults are obese compared to white adults (42 %) and Asians (17%).

In this study, white adults with obesity had a lower prevalence of prescription drugs (7.7%) compared to black adults (9.8%) and Hispanic adults ( 10.7%). Young adults (ages 18-44) and female respondents were also more likely to be prescribed diet pills.

“The implication is that structural barriers hinder access to medication for Black and Hispanic adults with obesity, which may worsen in the absence of expanded GLP- 1’s, and it’s possible that comprehensive insurance could improve some of these issues,” Chen. tell the attendees.

For this study, researchers analyzed data from non-pregnant adults surveyed by the National Health Interview Survey from 2020-2022. They included all respondents who took prescription drugs and answered all questions about drug distribution, but excluded respondents with diabetes to avoid including potential drug users. of GLP-1 or are given insulin. Respondents were asked if they had skipped medication, taken less medication, or delayed filling a prescription to save money during the past 12 months.

Of the 51,720 respondents, 33.9% were obese, defined as a body mass index (BMI) of at least 30. The mean age was 51.2, 58.4% were were female, 80% were white, 9.7% were Black, 9.7% were Hispanic, and 4.4% were Asian.

Oral Semaglutide Meets endpoints at low dose

A 25-mg daily oral dose of semaglutide resulted in significant weight loss and improved physical activity and cardiometabolic measures compared with placebo, a trial of OASIS 4 unusual showed.

Participants taking oral semaglutide lost an average of 13.6% of their body weight over 16 months, while placebo participants lost an average of 2.2% (Q<0.0001) in an intention-to-treat analysis, reports W. Timothy Garvey, MD, of the University of Alabama at Birmingham.

At 64 weeks, 79.2% of semaglutide participants and 31.1% of placebo participants had lost at least 5% of body weight (OR 7.3, 95% CI 4.2–12.8, Q<0.0001). More semaglutide participants also lost at least 10% (63% vs 14.4%; OR 9.1, 95% CI 4.7–17.3, Q<0.0001), 15% (50% vs 5.6%; OR 15.7, 95% CI 6.2–40.2, Q<0.0001), and 20% (29.7% vs 3.3%; OR 12.2, 95% CI 3.7–40.3, Q<0.0001) of their body weight at this time.

Oral semaglutide 25 mg is no longer approved by the FDA for weight management. 7-mg and 14-mg doses of oral semaglutide are currently approved for type 2 diabetes under the brand name Rybelsus.

“The availability of oral GLP-1-based medications gives patients an option for those who would prefer to be taken orally rather than injected,” Garvey said. MedPage Today. “Adherence to medication is lacking in obesity medicine, and it is predictable that oral medications will be associated with long-term adherence in many patients.”

The previous phase III OASIS 1 study showed that 50 mg of oral semaglutide once a day resulted in an average of 15.1% weight loss compared to a 2.4% loss with placebo.

“There’s a medical principle that you always use the lowest dose that works,” Garvey said. “In the case of oral semaglutide for overweight/obesity, it seems that 25 mg per day is the dose.”

The trial enrolled 243 participants with a BMI of at least 30, or 27 with a weight-related comorbidity, in areas of Canada, Germany, Poland, and the US Mean age was 48 years , 78.8% were female, and 91.5% were white. ; BMI was 37.6.

Participants were excluded if they had an HbA1c level of at least 6.5% or lost at least 5 kg of their body weight during the 90 days before the study examination.

167 participants in the semaglutide group started at 3 mg, which increased to 25 mg at 12 weeks. Both groups entered a lifestyle intervention program that included eating fewer calories 500 per day and at least 150 minutes of physical activity per week.

The estimated change in the Impact of Weight on Quality of Life (IWQOL)-Lite-Clinical Trials version of physical activity was 16.2 for the semaglutide group versus 8.4 for the placebo group at 64 weeks (Q=0.0006). Additionally, 55.3% of semaglutide participants reported a clinically meaningful increase in physical fitness compared to 34.8% of placebo participants (Q=0.002).

Semaglutide participants also reported a significant decrease in C-reactive protein (-46.4 vs -4.2, Q<0.0001), HbA1c (-0.29% vs -0.06%, Q<0.0001), and triglyceride levels (-18.4 vs -7.5 mmol/L, Q=0.014).

Among the 129 participants who had prediabetes at baseline, 71.1% of semaglutide participants and 33.3% of placebo participants achieved normoglycemia.

The most common adverse events with semaglutide were nausea (46.6%), vomiting (30.9%), and constipation (20.1%); 3.4% of semaglutide participants discontinued the trial due to gastrointestinal side effects compared to 2% of placebo participants.

GLP-1 Medications Associated with Reduced Risk of Hypertension in Adolescents

Obese teens who took a GLP-1 receptor agonist were half as likely to develop high blood pressure over the next decade compared to those who took other anti-obesity drugs, according to retrospective analysis of a national database of electronic medical records.

At 5 years after starting antiobesity medication, 2.12% of adolescents taking GLP-1 drugs and 3.96% of those taking other antiobesity drugs developed hypertension (hazard ratio) . [RR] 0.54, 95% CI 0.36-0.81), reported Shradha Chhabria, MD, MPH, of University Hospitals Cleveland Medical Center and Rainbow Babies and Children’s Hospital at Case Western Reserve University School of Medicine in Cleveland.

At 10 years, 2.12% and 4.08% developed hypertension, respectively (RR 0.52, 95% CI 0.35-0.79).

An estimated 20% of U.S. youth are obese, and nearly one in four have high blood pressure, which increases their risk of illness and death, Chhabria said. .

“The existing literature clearly shows the effectiveness of treating obesity itself, but our study contributes to the evidence by supporting a higher level. [of GLP-1 medications] than other anti-obesity medications to prevent the development of obesity-related comorbidities in the long term,” although this study cannot show causation, Chhabria said.

Researchers analyzed data from the TriNetX database to assess blood pressure in obese adolescents 5 and 10 years after starting to use GLP-1 or other anti-obesity drugs.

They used a method to compare 1,925 adolescents who took semaglutide (Wegovy), liraglutide (Saxenda), dulaglutide (Trulicity), or tirzepatide (Zepbound) to 1,923 adolescents who took any of the following: bupropion, phentermine , topirane, naltat, naltat Xenical, Alli), or metformin.

The average age of the participants was 15, and 61% were female. Mean BMI was 41.7 in the GLP-1 group and 37.9 in the other group. Nine percent of both groups had type 2 diabetes, and a similar number had high cholesterol, a metabolic-related disorder. and steatohepatitis (MASH), a variant of fatty liver, thyroid disease and sleep apnea.