Semaglutide, the active ingredient in Novo’s Wegovy and Ozempic, and tirzepatide, sold as Zepbound and Mounjaro by Lilly, are so effective that they should be the first choice in almost all cases when substantial weight loss is necessary, according to a new guideline from the European Association for the Study of Obesity published in Nature Medicine.
When a lesser degree of weight loss is required, other medications can be considered, including liraglutide, an older, less effective drug from the same class, naltrexone-bupropion, and phentermine-topiramate, the guideline says. The EASO guidelines are non-binding on individual countries.
Semaglutide, tirzepatide, and other drugs from the class known as GLP-1 agonists are completely transforming care of obesity and its complications, coauthor Dr. Andreea Ciudin of Vall d’Hebron University Hospital in Barcelona said in a statement.
Although no treatment algorithm can replace the nuanced clinical judgment necessary for comprehensive patient care, the new guidelines can serve to support therapeutic decision-making in obesity, she said.
SPECIFIC DRUGS FOR SPECIFIC CONDITIONS
The guideline authors analyzed previous clinical trial results, evaluating the impact of medications on weight loss, their safety profile, and their effectiveness in the presence of specific complications. For patients with the physical consequences of too much fatty, or adipose, tissue, tirzepatide should be considered as the first-line treatment for addressing obstructive sleep apnea, and semaglutide for those with knee osteoarthritis, the authors determined.
For patients with conditions linked with obesity-related metabolic and immune dysfunction, they recommend semaglutide as a first choice for those with a history of heart disease or stroke, tirzepatide for individuals with non-alcoholic fatty liver disease, and either tirzepatide or semaglutide for those with prediabetes or type 2 diabetes.
The class of drugs was originally developed to treat type 2 diabetes.
While the drugs are expensive and economic considerations are complex, the cost of not treating obesity at early stages, “thus enabling the progression to complications and end-organ damage, should be weighed equally in health policy and clinical decision-making,” the guideline authors wrote.
The management of obesity should not be limited to weight loss and its complications but should focus on enhanced mental well-being, physical fitness, social functioning, and overall health and quality of life as well, they also said.
Most of the newer medications have not been evaluated for the treatment of individual complications, they acknowledge.
Still, the authors say, the weight-loss effects have been strongly associated with improvements in various complications and there is growing potential for them to positively influence a broader range of disorders such as chronic kidney disease, neurodegenerative diseases, polycystic ovary syndrome, certain cancers, and mental health conditions.
“Given the rapid advances in the field of medications to treat obesity, EASO intends to update the present treatment algorithm regularly to incorporate the latest available evidence,” society President Professor Volkan Yumuk of Istanbul University-Cerrahpaşa said in a statement.
The American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society jointly advised in June that GLP-1 treatment must be accompanied by nutritional and lifestyle strategies.
“Although GLP‐1s alone can produce significant weight reduction and related health benefits, several challenges limit its long‐term success for individuals and populations,” including gastrointestinal side effects, risk of nutrient inadequacies, muscle and bone loss, high costs, frequent discontinuation, and weight regain,” the advisory said.
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