The Bicycle Race

Racing Toward Better Anti-Obesity Medicines

There’s a race heating up. It is a race to open the way for better obesity care and deliver better options. In this race, semaglutide (Wegovy™) has a head start. But a pack of other options are on the way. Yesterday in JAMA, results in a study of tirzepatide for treating type 2 diabetes tell us once again that this investigational drug can also yield impressive results for people with obesity. The race for better anti-obesity medicines is heating up.

Wegovy Clearing a Hurdle in the UK

In the UK yesterday, NICE (the National Institute for Health and Care Excellence) recommended that Wegovy be offered in the National Health Service. The recommendation is that it should be offered only in specialized obesity care programs and only for up to two years of therapy. This limit stands in contrast to the chronic nature of obesity. Helen Knight, a program director at NICE, described obesity clearly enough:

“We know that management of overweight and obesity is one of the biggest challenges our health service is facing with nearly two thirds of adults either overweight or obese. It is a lifelong condition that needs medical intervention, has psychological and physical effects, and can affect quality of life.”

So the two year limitation has us scratching our heads.

Another head scratcher is the pricing. In the UK, the list price is $99 for a pack of four syringes – a month’s supply. That same pack in the U.S. will cost $1,349. It really is hard to wrap our heads around such a big price difference.

But this is part of a bigger problem that means people in the U.S. pay the highest prices in the world for prescription drugs.

Competition on the Way

The tirzepatide study in JAMA reminds us that competition is on the way for better anti-obesity medicines. Of course this study was all about type 2 diabetes. Patients could enter the trial with a BMI as low as 23. However, the average patient in this study had a BMI of a little more than 33. Researchers tested three doses (5, 10, or 15 mg weekly), with a comparison to placebo.

At the end of this 40-week study, roughly half of the patients in the two higher dose groups lost more than ten percent of their starting body weight. More than a quarter of them lost 15 percent or more. These are impressive results, but they give us only an incomplete glimpse of the potential for this drug in obesity.

Tirzepatide is under review now at FDA for an indication to treat diabetes. An obesity indication will come a few years from now. But clearly it is coming and you can be sure that competition will heat up as Pfizer and others enter this field.

We can only hope this competition will not only bring better options, but also more competitive pricing.

Click here for the study in JAMA and here for an editorial that goes with it. For more on the NICE decision, click here and here.

The Bicycle Race, painting by Lyonel Feininger / WikiArt

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February 9, 2022