Domestic Pig Kidneys

The Intersection of Heart, Kidney, and Metabolic Outcomes

The handwriting is on the wall. Insurers can’t avoid covering obesity drugs forever, said a recent analysis from Bloomberg and they were right. What prompted that conclusion is the cascade of health outcome studies that make it unmistakeable. Treating obesity and and related metabolic diseases with advanced medicines like semaglutide has a dramatic effect on the length and quality of life. On Tuesday this week, another study with dramatic results at the intersection of heart, kidney, and metabolic outcomes told us this is true.

Novo Nordisk halted the FLOW trial of semaglutide in chronic kidney disease and type 2 diabetes a year early because the efficacy outcomes were so positive. The mean BMI of patients in this study was 32 – a value suggestive of obesity.

Blinded Results, Scant Details

To be clear, this is good news, but the details are scant for now. All we really know is that the outcomes were so good that an independent data monitoring committee recommended stopping the trial early, in accordance with prespecified guidance for such a decision. The dose of semaglutide was the 1 mg weekly injection used for diabetes treatment – not the 2.4 mg weekly dose recommended for obesity.

The primary outcome measure for the study was a composite of kidney disease progression and deaths due to heart or kidney disease. Clearly, these are patients with a significant burden of disease and it appears that semaglutide lifted some of that burden. However, we will not have full details until the data is fully analyzed and reported. Not before the first half of 2024.

Health Outcomes Adding Up

The outcome benefits of semaglutide in obesity and diabetes are adding up. The biggest news came from the SELECT trial. From that, a 20% reduction in strokes, heart attacks, and cardiovascular deaths emerged in August. People expect to see a presentation of the full results in November at the American Heart Association meeting. An outcome study in heart failure with semaglutide is another bit of good news.

Related to all of this is a new study of Latino and Hispanic persons this week in the Journal of the American Heart Association. The intersection of heart, kidney, and metabolic disease was on vivid display in this study. For the risk of sudden cardiac arrest, chronic kidney disease was the strongest risk factor. We also note that diabetes was present in 62% of the persons who suffered a sudden cardiac arrest.

Yes, the outcome benefits are adding up. So it is no surprise to hear from Bloomberg that we need to change our view of obesity treatment:

“As a society, we seem stuck in an old narrative: that Wegovy and its rivals are merely ‘lifestyle products’ that offer a cosmetic, but not societal benefit. Today’s data underscores the need to update that story.”

That old narrative is an antique on the verge of turning into junk.

Click here and here for the news of the FLOW study, here for more details about the study design. For the study of cardiac arrest and kidney disease, click here.

Domestic Pig Kidneys, photograph by Wagner Souza e Silva and the Museum of Veterinary Anatomy FMVZ USP, licensed under CC BY-SA 4.0

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October 13, 2023