Liraglutide for Obesity Looking Like Diabetes Prevention
An impressive new three-year study of 3 mg liraglutide for obesity (Saxenda) finds that this therapy provides a large reduction in the risk of developing diabetes in people who have prediabetes. Published yesterday in Lancet, investigators found an 80% reduction in the risk of progressing to diabetes. In a post-hoc analysis, they made further assumptions about patients who withdrew from the study. With those assumptions, they produced a more conservative estimate of a 66% reduction in risk.
Whichever number you choose, these results are impressive because this risk reduction comes on top of the reduction in risk that lifestyle interventions can yield. In this randomized controlled study, people in both the active and placebo groups received standard lifestyle therapy with diet and exercise. Lifestyle interventions can provide a 40-70% reduction in the risk of progressing to diabetes.
Of course, achieving and maintaining a lower weight is an important outcome, too. After three years, people on liraglutide maintained a weight loss of about 6% on average. That was three times the weight loss that people who relied on just diet and exercise could maintain.
In a companion commentary, Olivia Farr and Christos Matzoros raise the important question of cost effectiveness, which this study does not answer. However, in their commentary they seem to miss the fact that the comparison group of the present study was lifestyle modification. In the face of data to the contrary, they say that “lifestyle modification appears to be equally effective at three years as liraglutide.”
Such is the bias against treating obesity that people tend to look past what the data actually show.
But as time goes by, preventing diabetes and all the complications that come with that disease looks increasingly important. This might be might become the factor that drives progress in obesity care. After nearly two years in the market, Saxenda is still growing robustly while other new obesity treatments are struggling. Saxenda brings with it a strong track record in diabetes. More than three million patient years of experience with liraglutide in diabetes might be helping this product gain a foothold.
Physicians are extremely reluctant (unfortunately) to treat obesity. Their familiarity with liraglutide, combined with a continuing stream of good clinical results, might help to overcome that reluctance.
Click here for the study, here for the commentary, and here for more from Medical Xpress.
Stopped Watch, photograph by JD Hancock, licensed under CC BY 2.0
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February 23, 2017
February 24, 2017 at 12:03 am, Walt Medlin said:
I would love to prescribe this more – but don’t know how many will have huge bills – we have got to try it more for our DM patients after WLS also
February 24, 2017 at 3:51 am, Ted said:
Drug reimbursement for obesity is a game that is most annoying. It’s all about drug plans trying to avoid paying a bill. I’ve been around the block on this for my meds a few times.
February 25, 2017 at 4:49 am, David Propst said:
“Physicians are extremely reluctant…” Not true. Cost for these meds is outrageous for no or poorly sustained (6%) results.
February 25, 2017 at 5:51 am, Ted said:
Thank you for sharing your views, David.
Cost of medical care is a broad issue. New drugs add to those costs and liraglutide is definitely an expensive new drug, though it does not reach the heights of some specialty pharma products. Regarding “no or poorly sustained results,” an average of 6% weight loss maintained for three years has a significant effect on reducing the complications of obesity. As documented in this study, it had a large effect on preventing the progression of prediabetes to diabetes.
Such comments, dismissing these benefits documented in a randomized controlled trial, suggest to me a reluctance to treat. But that is just my opinion. What has been documented elsewhere is that very few primary care physicians will prescribe anti-obesity medications for patients in whom they are indicated. They also falsely believe that behavioral change is more effective than bariatric surgery.
As a result, the care that most people with obesity get from a primary care physician is advice to eat less, move more, and lose weight. It doesn’t help. Someone living with obesity has usually tried that strategy over and over again. More often that not, it’s not enough to change the course of this disease.