One, Two, Three: Multi-Agonists for Obesity at EASD 2023

Still Life with Three PuppiesIt’s enough to make our heads spin. The incredible vibrancy in obesity research is on full display at the meeting of the European Association for the Study of Diabetes – EASD 2023 in Hamburg. Today, it starts with a bang. Successive presentations on multi-agonists for obesity are scheduled this afternoon at EASD. But the abstracts are already published online in Diabetologia.

We have seen the a glimpse of the future and it is impressive.

Retatrutide and More

Of course, ever since scientists published the phase 2 research with retatrutide in obesity, this triple agonist therapy has been the hot ticket for understanding how far obesity medicine can go. Remarking on the data being presented at EASD, obesity medicine physician Beverly Chang tells us:

“It’s kind of amazing that we’re now measuring weight loss in days. We may need to get ahead of any safety concerns and write protocols for excessive rapid weight loss.”

She was reflecting on results from a phase 1 study of CT-388. It is a dual agonist that works on both GLP-1 and GIP receptors. After just 29 days in this small study, patients lost 8.5% of their initial body weight. Of course, these data come from a very small study at an early stage of this medicine’s development. So we have much more to learn.

There is much more to come. Beyond CT-388, today’s session will offer data on retatrutide, cotadutide, survodutide, and pemvidutide. Then later we get data on tirzepatide – which is in line for FDA approval to treat obesity – from the SURMOUNT-4 study of weight maintenance out to 88 weeks of therapy. Yet another EASD session explores the mechanisms by which these multi-agonists may be acting in obesity and diabetes. In this session, we will get a glimpse of yet another GLP-1/GIP drug – CT-868. There’s no data on obesity for this one yet. Just data on how it works.

Disorienting for Lifestyle Medicine Evangelists

This is a lot for all of us. Lifestyle medicine evangelists look at the world changing around them and they hardly know what to think. Some of them know that they hate it. They have a lifestyle program to sell and they seem to think that treating the physiologic problem of obesity is a threat to their business model. “Don’t make it complex when the metabolic impacts are obvious,” says one. “Ultraprocessed food consumption is designed to addict and adverse metabolic effects are imposed.”

We get it. If your whole world is built around coaching people with a minimal disease burden to prevent diabetes and obesity, then therapy for people with a bigger burden of disease is hard to comprehend.

But the fact is that many people now have a big burden of disease from obesity. They need and want medical care for it. And thankfully, scientific research is yielding amazing progress.

Click here for all of the abstracts from EASD and here for more on the evolution of multi-agonists for diabetes and obesity.

Still Life with Three Puppies, painting by Paul Gauguin / WikiArt

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October 3, 2023