Portrait of My Father

Tirzepatide Shows Good Weight Outcomes in Diabetes

Day by day, the prospects for treating obesity are getting better. Late on Monday, detailed results from the longest study yet of tirzepatide came out in Lancet. This was a study using this new drug in people with type 2 diabetes, but the average BMI of these patients was 33. None of them had a BMI less than 25. It was a randomized, controlled study with insulin treatment as the control group. In the primary outcome, diabetes control, tirzepatide was clearly better. But on the secondary endpoint of body weight, the outcomes with tirzepatide were also quite good.

Dose-Dependent Weight Outcomes

This study employed three doses – 5, 10, and 15 mg given once weekly by injection. Even at the lowest dose, the drug appeared to be effective. Patients lost 8.1 percent of their starting weight after 52 weeks. But with each higher dose, patients lost more – 10.7 percent at 10 mg and 13.0 percent at 15 mg.

These are results that approach the level of efficacy seen with semaglutide (Wegovy), a drug widely described as a “game changer” in obesity care. So without a doubt, these are encouraging weight outcomes for tirzepatide. They tell is that we have every reason to believe Wegovy will not be the one and only step forward in obesity treatment we’ll be seeing over the next several years.

More to Come

Tirzepatide will go to FDA for an indication to treat type 2 diabetes before the end of the year. The pivotal studies for treating obesity are under way and will mostly be complete in 2023. One of them will yield further results in 2024. So we would not expect to see an FDA approval before 2024 or 2025.

But this is not the only new drug in development for obesity. Right behind tirzepatide at Lilly, a GGG tri-agonist (LY3437943) has moved into a phase 2 study. As we’ve noted before, Novo Nordisk and Pfizer also have new peptides in development for obesity. And then bimagrumab is showing promise, too.

Success begets more success. Ten years ago, obesity seemed like a graveyard for new drug development. Today, Novo Nordisk has two emerging blockbusters for this indication – Wegovy and Saxenda. So it’s not surprising that Lilly and others would come around to the view that they cannot innovate in metabolic disease care without getting serious about obesity.

Now the rest of the world will have to catch up and stop pretending that obesity is merely a behavioral problem. We’re getting there.

Click here for the new study in Lancet, here for more on it from Lilly, and  here for more on the emerging innovation in obesity drug development.

Portrait of My Father, painting by Salvador Dali / flickr

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October 20, 2021