New medication showing promising early weight loss in trials

Tirzepatide – Once Weekly Injection for Obesity.

 

There has been continued interest in GLP-1 medications for weight loss in Adelaide and the rest of Australia. It is a continuously evolving landscape, and one which will be of a benefit to patients in the years to come.

 

GLP-1 medications, such as Saxenda and Ozempic are an important adjunct, or additive, to weight loss surgery and I have had good results using them as such. I also use GLP-1 medications in my clinic, with diet and lifestyle modification, in consultation with our experienced allied health team, to improve on patient’s weight and routines. I have also used weight loss medications, and in particular GLP-1 agonists, as pre- and post-operative agents to continue to improve on the outcomes of surgery.

 

Weight loss surgery outcomes, from gastric bypass or sleeve gastrectomy, are of the range of 25-30% at 1 year, and around 30-35% at 2 years. Previous trials of semaglutide (2.4mg) resulted in a placebo-adjusted weight reduction of 12.4%, with nearly one third of patients having a reduction of 20% or more. The maintenance of weight loss is important, both on and off medication, and something that will continue to be assessed in further trials.

 

The NEJM trial published July 21, 2022 (https://www.nejm.org/doi/full/10.1056/NEJMoa2206038) is an important step forward in understanding the role of GIP and GLP-1 medications. It is part of a

 

Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1).

 

This was a phase 3 double blinded, randomised controlled trial, for patients with a BMI of > 30 or a BMI of > 27 with a weight-related comorbidity. It is important to note that diabetics were excluded from the trial.

 

Tirzepatide was given at dose of either 5mg, 10mg or 15mg, or a placebo for 72 weeks. The key endpoints were % change in weight, and a weight reduction of 5% or more.

 

The results of the study were significant, with more weight loss than previous medications. The mean percentage change in weight at 72 weeks was -15.0% with 5mg, -19.5% with 10mg, and -20.9% with 15mg. The placebo provided -3.1% weight loss.

 

In regards to the number of patients who achieved a weight loss of 5% or more, this was: 85% for 5mg, 89% for 10mg and 91% for 15mg. It is interesting to note that 35% of the placebo group lost 5% or more.

 

Further to this, 35% of the 5mg group, 50% of the 10mg group and 57% of the 15mg lost 20% or more of their body weight, with 3% of the placebo group losing 20% or more of their body weight during this time. In regards to adverse events, this was low, at 4.3% for 5mg, 7.1% for 10mg and 6.2% for 15mg. 2.6% of the placebo group discontinued treatment also.

 

The 72-week phase 3 trial demonstrated significant weight loss. This is promising data, however further trials are necessary to assess outcomes over a longer period, as well as after cessation of medication.

 

It is important to note that there are more options becoming available for patients with obesity, and as a bariatric or weight loss surgeon practicing in Adelaide, I continue to provide all options for my patients. Therefore, I provide surgery, as well as medical treatments and non-operative treatments including the Allurion Balloon. Well-rounded care, with options for patients is important and means better outcomes for patients long-term.  The addition of GIP/GLP-1 agonists to weight loss surgery such as sleeve gastrectomy and gastric bypass, may mean our team are able to achieve improved total body weight loss of over 40% or excess weight loss of above 80%. This could bring even further improvement to co-morbidities for patients with obesity.

 

It is always important to consult with a doctor. Please contact our rooms if you would like to book a consultation with me or a member of our clinical team to discuss your individual situation.

Thank you, Dr George Balalis.

 

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