ECO2024: Tailoring and Tapering Obesity Medicines

A pair of studies with semaglutide at ECO2024 in Venice goes straight to the heart of some core questions about advanced obesity medicines. Does everyone need the full, maximum dose to get good results? Will everyone have to keep taking that full dose to keep obesity under control? The answer to both questions is no. Tailoring and tapering the dosing of obesity medicines to individual patient needs can produce good results.

Specifically, researchers found that patients who tapered off semaglutide kept off lost weight for at least six months. A separate study found that lower doses of the drug can be effective for weight outcomes as higher ones. In other words, individual patient needs do vary. For obesity care, one size does not fit all.

Real World Data
from a Digital Health Program

These are data from the Embla digital health platform for obesity care. We take the findings with a grain of salt simply because these folks are seeking visibility for their new business venture and the details of the data and their analysis are not thoroughly vetted yet in a peer-review publication.

But nonetheless, these abstracts illustrate a couple of important points. First that the notion of a fixed dose of 2.4 mg for semaglutide – or a fixed dose of any obesity medicine for that matter – is absurd. Some pharmacy benefit managers are using the labeled 2.4 mg dose for Wegovy (semaglutide) as a do-or-die criteria for continued reimbursement of the drug. If the patient takes a lower dose, they won’t cover it. That is nothing but a lame excuse.

Taking the Same Drug Forever?

The other point to consider is that people may be making far too big a deal about the need for taking an obesity medicine forever. Yes, obesity is a chronic disease. Without continued care, it will come back. Physiology will drive a person’s body to gain weight.

The reason for tailoring obesity medicines is to meet the individual needs. Some people may be able to taper off semaglutide and use other tools to maintain their improved health status. Others may need to continue with a lower dose or a different drug. No single path will work for every patient – the disease is not only chronic, it is heterogeneous.

So these data, telling us that tailoring and tapering obesity medicine doses can be helpful, is a welcome reminder. Obesity care is not a one-size-fits-all endeavor.

Click here and here for the study abstracts, here and here for further perspective.

Venice, painting by Aleksandra Ekster / WikiArt

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May 12, 2024