HelixTalk #142 - New Gains in Weight Loss Pharmacotherapy

Date posted: January 18, 2022, 6:00 am

In this episode, we will build up on our previous Weight loss Pharmacotherapy Episode, episode #13 to discuss updates in guidelines, prevention of obesity from comorbidity standpoint, and new treatment agents for weight-loss with a particular focus on Contrave (naltrexone/bupropion), Saxenda (liraglutide), and Wegovy (semaglutide).

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Key Concepts

1. Obesity is a chronic disease with multiple negative health implications and it should be treated like other chronic diseases.
2. The optimal treatment of obesity is multidisciplinary and multifactorial -- including healthy behavioral changes (lifestyle modifications), anti-obesity medications, management of underlying causes, and potentially metabolic surgery.
3. Contrave (naltrexone/bupropion) is an oral therapy for obesity approved in 2014. The bupropion dose is similar to bupropion in other indications (such as depression and smoking cessation). As with the other indications, Contrave can increase the risk of seizure, especially in at-risk patients (history of seizure, eating disorder, alcohol use disorder, etc.).
4. The GLP-1 agonists, Saxenda (liraglutide) and Wegovy (semaglutide), are injectable therapies previously approved for type 2 diabetes but now have FDA indications for obesity (regardless of diabetes status). The dose of these medications for obesity is much higher than the dose for type 2 diabetes.
5. Comparative data from the STEP 8 trial demonstrates that weight loss with Wegovy (semaglutide) is much greater than with Saxenda (liraglutide).

References

• Hall ME, Cohen JB, Ard JD, et al. Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association. Hypertension. 2021;78(5):e38-e50. doi:10.1161/HYP.0000000000000202
• American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee:, Draznin B, et al. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Supplement_1):S113-S124. doi:10.2337/dc22-S008
• Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619
• Rethink Obesity® https://www.rethinkobesity.com/