A Wondering Gaze in a Wandering Maze

Confusion and Progress in Obesity Care

Treatment Gap PyramidAmple confusion and progress can be found right now in the work of developing and delivering new medications for obesity care. Though we have some good options for treating obesity, we have a tremendous gap of unmet need between the extremes of behavioral therapy and surgical treatments for obesity. Though four new obesity meds have been approved in the last four years, the range of options is still far too small.

On the progress side of the equation, we have robust investment in obesity drug development continuing to unfold at Novo Nordisk, which has opened an obesity research center in Seattle. Not only is its new obesity treatment (Saxenda/liraglutide) finding good acceptance by doctors who treat obesity, but the company is continuing to invest in clinical trials for it. Presented at the annual meeting of the Endocrine Society in Boston, results of a phase one trial (safety only) in adolescents are part of a range of research that goes beyond what we are seeing from other companies in this space. Everyone else is largely ignoring adolescents. But it doesn’t stop there. The company has other obesity drugs in their R&D pipeline.

To be clear, others have some good things coming. We hold high hopes for the cardiovascular outcomes trial of Belviq (lorcaserin) ongoing by Eisai. Results are due in 2017. A positive outcome would not only help Belviq. It might also have positive spillover effects for the category.

On the confusion side of the equation you will find the puzzling news that a second cardiovascular outcomes study for Contrave (naltrexone/bupropion) – barely underway – was just halted. Apparently Orexigen, which just took over full responsibility for the drug, wants to retool the study. But given an earlier blunder that halted the first attempt at an outcomes study for Contrave, this move is a bit of a head scratcher. We suppose that it’s just a consequence of the transition back to Orexigen. That’s what Orexigen CEO Mike Narachi said to explain his company’s action:

We undertook a careful assessment and determined that the transfer of current clinical trial operations and systems would have a significant interruption on study conduct and possibly risk data integrity. We are committed to conducting a high quality cardiovascular outcomes trial to meet our post-marketing obligations on time, and we believe strongly the right way to run that study is under our IND with our clinical operations team, contracts and vendors.

These are early days in the development of serious efforts to meet the need for obesity care. We expect considerable confusion and progress to keep coming for many years.

Click here for more on the Contrave outcomes study.

A Wondering Gaze in a Wandering Maze, photograph © Tom Wachtel / flickr

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April 15, 2016

4 Responses to “Confusion and Progress in Obesity Care”

  1. April 15, 2016 at 9:42 am, Stephen Phillips said:

    Bariatric science is an emerging science. Research has begun to unravel the
    plethora of chemical messengers that start and stop a meal. Identifying these messengers are the prerequisite to mitigating them.. The future is bright for a new class of pharmaceuticals for obesity treatment.

    Stephen Phillips
    American Association of Bariatric Counselors

  2. April 15, 2016 at 4:55 pm, Allen Browne said:

    I would suggest putting weight loss devices (WLD’s) in your pyramid and to somehow include combinations of WLD’s and weight loss medications (WLM’s).

    Unfortunately we have very little confusion ( nothing is being done) and very little progress for the children. I think you are right,”these are the early days in the development of serious efforts to meet the need for obesity care”.

  3. April 16, 2016 at 4:49 am, Ted said:

    Good point, Allen. Thanks.

  4. April 16, 2016 at 9:33 pm, Joan Ifland said:

    We have a good solution for obesity that is inexpensive and easy to implement. The confusion comes from ignoring food addiction protocols which work well to control cravings and have a cascade of positive side-effects.