New data show most US patients now stay on Wegovy, Zepbound after a year
IANS Representational Image
Nearly two-thirds of patients who started on weight-loss drugs Wegovy or Zepbound last year were still taking them a year later, according to an analysis of U.S. pharmacy claims.
That level of persistence is higher than what prior analyses have shown, suggesting that more patients might be staying on the popular GLP-1 drugs for obesity as product shortages ease, insurance coverage expands and doctors manage side effects better, health experts say.
Sixty-three percent of patients starting on Novo Nordisk's Wegovy or Eli Lilly's Zepbound during the first quarter of 2024 were still taking them 12 months later. For Wegovy, that was up significantly from 40% who started therapy in 2023 and 34% who began three years ago in this analysis by Prime Therapeutics, a pharmacy benefits manager (PBM). Patrick Gleason, Prime's assistant vice president for health outcomes and a co-author of the analysis, said he was surprised to see persistence rise above 50%. "It's a near doubling from one-third persistent to roughly two-thirds now," Gleason said. "This is a dramatic change, and I believe this is more reflective of what we will see going forward."
Zepbound's results were relatively unchanged year over year, though the number of U.S. patients starting on the medication in 2023 was limited since it did not launch until November of that year. Wegovy was approved in June 2021. The analysis shared with Reuters does not include details about why patients continued or stopped therapy. Some people have reported stopping because the drugs became unaffordable or their insurance no longer covered them. Others quit due to common gastrointestinal side effects, inability to get refills due to supply shortages or achievement of their weight-loss goal, among other factors. Studies have shown that most patients who quit their GLP-1 drugs usually regain most of the weight. The medications may require extended use to yield meaningful benefits for patients' health. Many employers and government agencies remain wary of adding coverage for these highly effective, but expensive medicines due to the significant upfront investment and uncertainty about any future savings. Dr. Ezekiel J. Emanuel, co-director of the Healthcare Transformation Institute at the University of Pennsylvania, said low persistence on these weight-loss drugs had been concerning and the new data might indicate that increased insurance coverage is helping to turn the tide. Novo declined to comment on the data, and Lilly did not immediately respond to a request for comment. Prime is owned by 19 U.S. Blue Cross and Blue Shield health insurance plans and manages pharmacy benefits for about 73 million people. In its analysis, Prime reviewed pharmacy and medical claims for 23,025 people with commercial health plans who received prescriptions for either Wegovy or Zepbound and had a diagnosis of obesity. Prime excluded patients with a diabetes diagnosis in their medical claims or who were using a drug for type 2 diabetes, for which these GLP-1 medicines were originally developed. The mean age of patients in the year-over-year analysis was 46 and 77% were female. Patients were deemed persistent with their medication if they had no 60-day gaps in supply. The data allowed for switching among GLP-1 products. The data does not include patients who took compounded versions of the weight-loss drugs or paid for their prescription out of pocket outside of insurance. Prime also did a separate analysis of longer-term use. Only 14% of patients were still taking Wegovy after three years, the data show. That was a drop from 24% on Wegovy at the two-year mark. That longer-term analysis examined 5,780 patients who had remained enrolled in their health insurance for three years and did not have type 2 diabetes. The U.S. Food and Drug Administration removed semaglutide, the active ingredient in Wegovy, from its shortage list earlier this year and did the same for tirzepatide, the active ingredient in Zepbound, in December. Those moves eventually barred compounding pharmacies from making cheaper copies of the weight-loss drugs. Some patients have purchased these weight-loss medications directly from the drugmakers outside of their health insurance. Those prescriptions were not tracked in this analysis and that cohort of patients may behave differently, said David Lassen, Prime's vice president of clinical pharmacy services. "That group could have a different adherence pattern," Lassen said. "That's something we want to continue to watch."
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Considering Weight Loss Drugs? Is Natural Weight Loss More Sustainable And Healthier? Expert Answers
For years, new diets and eating patterns created a buzz in the weight loss industry. Now, weight management has entered a new phase in which weight loss drugs have gained all the attention. Unlike traditional diet and lifestyle changes, weight loss drugs seem like a quick solution that can help achieve the desired weight. From Wegovy to Mounjaro, weight loss drugs are now widely available in India and around the globe. For the unversed, weight loss drugs are prescription drugs that are primarily used to treat type-2 diabetes. These injectable drug help manage blood sugar levels by mimicking two important hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) that regulate insulin secretion and appetite. Due to their weight loss effect, it has become immensely popular among individuals who are overweight or obese but do not have diabetes. How do they work? Dr. Ambrish Mithal, Chairman & Head - Endocrinology & Diabetes at Max Healthcare explained, "The present batch of weight loss drugs is they all work through the GLP-1 pathway. The GLP-1 is a hormone that is secreted in the gut and acts on the pancreas to control diabetes but also acts on the brain to reduce our appetite and improve our satiety. Now what these drugs do is they mimic GLP-1-like action because the GLP-1 produced in our body breaks down in one or two minutes." "So these drugs act on the brain and help reduce the appetite as well as improve satiety, making you eat less and ultimately resulting in weight loss. They also slow down stomach movement, delaying emptying of the stomach." Weight loss drugs Vs natural weight loss Calorie restriction, intense exercise routines, fasting and many other approaches are some of the common methods that have helped many lose weight in the past. While weight loss drugs can help with rapid weight loss with fewer lifestyle adjustments, the risk of regaining weight if healthy lifestyle changes haven't been implemented remains high. On the other hand, natural weight loss methods, such as a balanced diet and regular exercise, promote a healthier lifestyle that is more likely to lead to sustained weight management. However, weight loss through natural methods tends to be slower, which can be discouraging for some individuals. "Losing weight naturally is always better than using drugs to do that. The challenge is that when people are significantly overweight, losing weight naturally does not come easily. We face that all the time in the clinic, we have patients who are struggling for years and years while trying to lose weight, actually don't succeed and if they do, the weight comes back on very soon," said Dr. Mithal. "The brain is wired in a particular way that you cannot control your food cravings, especially sweets. 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Natural weight loss methods are generally more sustainable and promote better overall health in the long run. It is best to consult your doctor to choose the best weight loss approach. Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
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Mounjaro and Wegovy have hit the market, and with this the global weight loss revolution has come to India. Dr Ambrish Mithal's book— The Weight Loss Revolution— that's released on Wednesday provides a detailed insight into these weight management drugs and how to use them, in the Indian context. Speaking to HT about the book, Dr Mithal— a renowned endocrinologist— highlights the need for generating awareness among masses about the role of these drugs, who are the right candidates for it, and the side-effects— even though mild— that one is likely to experience. Dr Ambrish Mithal Does it look like we have reached the stage where no less than a revolution is needed for weight-loss? Excess weight is a precursor to most modern metabolic disorders but unfortunately the tools to help us lose weight have been very limited. It's been more or less a disaster actually except for extreme cases when you went for surgery, which was utilised by a very small proportion of the population. You really didn't have much by way of drugs that help you lose weight. So, the reason I called it the weight loss revolution was that to address the modern metabolic sort of issues, we need to address weight. And for the first time, this whole crop of drugs that is coming out now, they are changing the way we look at it because they provide us the ability to actually help reduce excess fat and, therefore, reduce all the consequences of excess fat. I think it's a revolution because before this, you were struggling with much lower degrees of weight-loss. Do you think people still are largely ignorant about the harm that being obese does in terms of health? Yes, a majority of people look at weight as a cosmetic problem. And even now I am surprised every other day when I explain the relationship between something as obvious as wait and diabetes, many patients are unaware of the association. Even if they do understand the relationship between health and weight, sometimes that is not enough motivation for them to dive deep into obesity. People get motivated much easier by cosmetic issues than health issues. How is the current class of weight-loss drugs different from its predecessors? This is the class of drugs called GLP1 drugs, and this class we have been using now for almost two decades. These were developed for treating diabetes, and the initial ones worked very well for diabetes with additional benefits of weight-loss. Research in this area continued— the molecule kept on getting modified— and what made the semaglutide standout was the degree of fat-loss achieved, which was remarkable. It hit 15-16% of the baseline weight that had never been seen before. This is the same class of drugs— GLP1— but the incremental improvements were such that the degree of weight-loss one could achieve was substantially greater. Semaglutide and another molecule called tirzepatide (mounjaro)— a dual GIP and GLP-1 receptor agonist— have crossed the line for us in terms of efficacy and broken the barrier of treating obesity. What about the side-effects of these drugs? Anything that has effects will have side-effects. Fortunately, these drugs don't seem to have any sinister long-term side-effects, but yes, tolerability can be an issue with symptoms such as nausea, vomiting, constipation, or diarrhoea that in selected patients— a small proportion— can be troublesome. But these are transient effects. Some other long-term effects related to the eye etc. are still in the realm of research. Can the weight come back later, if one stops taking these drugs? In severely obese patients and patients with disorders linked with obesity, it certainly is going to be a life-long therapy. There, however, is a huge chunk of people who are in-between and we don't know yet whether all of them should be on life-long therapy or not. There's likely to be a period of aggressive weight-loss and then a period of weight maintenance that would probably require much lower doses. These drugs need to be a part of weight management programme and not a standalone treatment for obesity. The weight can come back after stopping these drugs, if you haven't tailored your lifestyle significantly.
Economic Times
5 hours ago
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New data show most US patients now stay on Wegovy, Zepbound after a year
IANS Representational Image Nearly two-thirds of patients who started on weight-loss drugs Wegovy or Zepbound last year were still taking them a year later, according to an analysis of U.S. pharmacy claims. That level of persistence is higher than what prior analyses have shown, suggesting that more patients might be staying on the popular GLP-1 drugs for obesity as product shortages ease, insurance coverage expands and doctors manage side effects better, health experts say. Sixty-three percent of patients starting on Novo Nordisk's Wegovy or Eli Lilly's Zepbound during the first quarter of 2024 were still taking them 12 months later. For Wegovy, that was up significantly from 40% who started therapy in 2023 and 34% who began three years ago in this analysis by Prime Therapeutics, a pharmacy benefits manager (PBM). Patrick Gleason, Prime's assistant vice president for health outcomes and a co-author of the analysis, said he was surprised to see persistence rise above 50%. "It's a near doubling from one-third persistent to roughly two-thirds now," Gleason said. "This is a dramatic change, and I believe this is more reflective of what we will see going forward." Zepbound's results were relatively unchanged year over year, though the number of U.S. patients starting on the medication in 2023 was limited since it did not launch until November of that year. Wegovy was approved in June 2021. The analysis shared with Reuters does not include details about why patients continued or stopped therapy. Some people have reported stopping because the drugs became unaffordable or their insurance no longer covered them. Others quit due to common gastrointestinal side effects, inability to get refills due to supply shortages or achievement of their weight-loss goal, among other factors. Studies have shown that most patients who quit their GLP-1 drugs usually regain most of the weight. The medications may require extended use to yield meaningful benefits for patients' health. Many employers and government agencies remain wary of adding coverage for these highly effective, but expensive medicines due to the significant upfront investment and uncertainty about any future savings. Dr. Ezekiel J. Emanuel, co-director of the Healthcare Transformation Institute at the University of Pennsylvania, said low persistence on these weight-loss drugs had been concerning and the new data might indicate that increased insurance coverage is helping to turn the tide. Novo declined to comment on the data, and Lilly did not immediately respond to a request for comment. Prime is owned by 19 U.S. Blue Cross and Blue Shield health insurance plans and manages pharmacy benefits for about 73 million people. In its analysis, Prime reviewed pharmacy and medical claims for 23,025 people with commercial health plans who received prescriptions for either Wegovy or Zepbound and had a diagnosis of obesity. Prime excluded patients with a diabetes diagnosis in their medical claims or who were using a drug for type 2 diabetes, for which these GLP-1 medicines were originally developed. The mean age of patients in the year-over-year analysis was 46 and 77% were female. Patients were deemed persistent with their medication if they had no 60-day gaps in supply. The data allowed for switching among GLP-1 products. The data does not include patients who took compounded versions of the weight-loss drugs or paid for their prescription out of pocket outside of insurance. Prime also did a separate analysis of longer-term use. Only 14% of patients were still taking Wegovy after three years, the data show. That was a drop from 24% on Wegovy at the two-year mark. That longer-term analysis examined 5,780 patients who had remained enrolled in their health insurance for three years and did not have type 2 diabetes. The U.S. Food and Drug Administration removed semaglutide, the active ingredient in Wegovy, from its shortage list earlier this year and did the same for tirzepatide, the active ingredient in Zepbound, in December. Those moves eventually barred compounding pharmacies from making cheaper copies of the weight-loss drugs. Some patients have purchased these weight-loss medications directly from the drugmakers outside of their health insurance. Those prescriptions were not tracked in this analysis and that cohort of patients may behave differently, said David Lassen, Prime's vice president of clinical pharmacy services. "That group could have a different adherence pattern," Lassen said. "That's something we want to continue to watch."
