5 updates on weight loss drugs

Sen. Bernie Sanders wants to schedule a meeting with Novo Nordisk's CEO after researchers said its blockbuster Type 2 diabetes drug, Ozempic, could remain profitable if it was made for less than $5, Bloomberg reported March 28. 

Its current cost is about $1,000 for a four-week supply. 

Ozempic and other GLP-1s have been in hot demand for months because of their weight loss results. Here are five other updates on these medications:

1. Hospital operations

GLP-1s are winding their way through transplant and bariatric departments at health systems across the U.S. For transplant programs, the weight loss drugs are helping donors and diabetic patients become eligible for surgeries since departments have strict cutoffs for people with higher body mass indexes. 

For bariatrics, demand for the medications is leading to a lull in operations and referrals. In Virginia, one bariatric surgeon is noticing 15% fewer referrals than normal, and in New York City, a bariatric surgery chief said the frequency of operations is declining between 10% and 20%. 

Healthcare workers are also waiting on more information on experimental therapies combining glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, and glucagon and glucagon receptors — or what might be the "third generation" of weight loss drugs.

2. Safety

About nine months after the American Society of Anesthesiologists recommended patients skip a GLP-1 dose before surgeries because of potential complications, a study has quantified the risk, which was previously only based on anecdotal reports. 

Researchers at Los Angeles-based Cedars-Sinai found that patients who take GLP-1s before endoscopy procedures are 33% more likely to experience aspiration pneumonia than other patients.

3. Access

As CMS gears up to cover Wegovy — a chronic weight management drug approved for cardiovascular disease — a recent study found that these powerful weight loss medicines aren't reaching obese patients. 

Researchers from Baltimore's Johns Hopkins University of Medicine reviewed more than 18,000 health records of patients who went to an outpatient clinic from January to September 2023, NBC News reported. Only 2.3% of those patients received a weight loss drug prescription, but the study authors weren't surprised amid the myriad of insurance barriers, drug shortages and stigma.  

In mid-March, Amazon Pharmacy signed a partnership with Eli Lilly, agreeing to help deliver its weight loss drug Zepbound and other medications. The FDA is not reporting a Zepbound shortage, but clinicians and patients told Bloomberg multiple doses are on back order. 

4. Demand

Only three GLP-1s are approved for weight loss: Saxenda, Wegovy and Zepbound. All others are indicated for Type 2 diabetes. Wegovy, which was approved in 2021, was recently surpassed by a new weight management drug for first-time prescriptions.  

For the week ending March 8, 77,590 new prescriptions were filled for Zepbound, which entered the market in December, and about 71,000 were filled for Wegovy. It's the first time Zepbound eclipsed Novo Nordisk's popular weight loss drug, but total Wegovy prescriptions remained higher than Zepbound by about 25,000 fills.

Nonadherence is a constant issue among patients taking long-term medications, but it seems to be a nonissue for those on GLP-1s, The New York Times reported. Physicians said their patients intend to take the new weight loss medicines forever. 

"Compliance is exceptional," Diana Thiara, MD, medical director of UCSF Health's weight management program in San Francisco, told the Times. "People take it. They ask for refills. They take it on trips."

5. Off-label uses

Another off-label use of GLP-1s is gaining traction among women seeking to prevent pregnancy complications. 

It's a tricky balance, experts said, since it is unknown how these therapies can affect fetuses. Until more data is available, the medical community is "all just kind of holding our breath," Andrea Shields, MD, vice chair of the American College of Obstetricians and Gynecologists' committee on clinical guidelines, told The New York Times.

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