The Rising “Tides” for Obesity Care

Anyone following the news on progress with anti-obesity meds might have noticed a rising number of news reports about various “tides” for obesity. Liraglutide is already out there. So is setmelanotide. Semaglutide injection is under review at FDA and approval is possible as early as the middle of this year. Tirzepatide is advancing in clinical trials for obesity, too. Last but not least is cagrilintide, which until now we only knew by its code name, AM833.

That’s a whole lot of rising “tides” for obesity care. This suffix simply means that these drugs are all peptides.

Incretins and Other Peptides

Dig a little deeper and you will find some differences. Liraglutide, semaglutide, and tirzepatide are are a specific kind of peptide called incretins. They act like GI hormones that regulate the production of insulin. They relate mainly to two hormones, GLP-1 and GIP.

Cagrilintide is slightly different. It is an analogue of amylin – a hormone that comes from the pancreas and also regulates insulin. Setmelanotide is entirely different and the first in its class – an MC4 agonist.

Why All the Excitement?

Stepping back from all these details, it’s worth noting that these peptides are creating considerable excitement. Semaglutide has stirred hope that anti-obesity meds might soon reach the level of efficacy that we’ve only seen before with bariatric surgery. It’s efficacy seems to be better than the drugs presently approved for obesity, but not quite at the the level that bariatric surgery provides.

Very early data on cagrilintide in combination with semaglutide came out in Lancet recently. It’s creating a buzz because of signals that this combination might provide yet another step forward in effectiveness.

Finally, tirzepatide brings a dual mode of action – working on both GIP and GLP-1 pathways. Its development program for diabetes is further along than obesity, but it has considerable promise for both indications.

Indeed, we have good reason for excitement. Success stimulates competition. Now Pfizer has a GLP-1 agonist in the pipeline for obesity treatment. It’s early days for this one, but competition is a good thing in this space. It will be an oral medication, which patients will like. An oral form of semaglutide for obesity is just now going in phase three clinical trials.

Until now, people living with obesity have had too few options. This is well on its way to changing. The tides are indeed rising for obesity care.

Click here for the study of semaglutide and cagrilintide in Lancet and here for further perspective in Medscape. For more on incretins in obesity, click here.

Rising Tide at Pourville, painting by Claude Monet / WikiArt

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May 21, 2021