signs point to glp-1 drug innovation beyond wegovy and ozempic

now, between 900,000 and 1.4 million canadians are currently using a glp-1 drug to manage weight loss and diabetes, according to a december 2023 national survey from dalhousie university’s agri-food analytics lab in halifax. the success of the drugs could also disrupt the food industry because cravings, especially among millennials taking the drug for weight loss, are reduced for impulse-buy snack foods like cookies and chips, ctv news reports .

both diabetes and obesity are flagged as growing public health crises in canada and around the world that also increase the risk of heart disease, stroke and cancer, and pose a burden on healthcare services. in canada, almost two-in-three adults and one-in-three children and youth are overweight or living with obesity with even higher rates in marginalized populations, says the public health agency of canada . and an estimated one in 10 canadians aged 20 years and older has been diagnosed with diabetes ; nine in every 10 of those diagnosed have type 2 diabetes, where adopting healthy lifestyle habits can improve management and reduce the damage.

dr. sean wharton, a leading obesity physician and internal medicine specialist in toronto, says the glp-1 drugs offer the scalable pharmacological intervention that has been missing for obese patients and an alternative to bariatric surgery that has its own risks. the first generation delivered between eight to 10 per cent weight loss, and now refined formulations are showing up to 25 to 30 per cent weight loss, which is well into the surgical levels achieved by a bariatric procedure, he told healthing.ca .

new treatments on the horizon

all that said, the next generation of glp-1 drugs could be game-changers. healthnews reports the following three patent applications have been filed for approval:

tri-receptor agonists for enhanced overall health benefits

the tri-receptor agonist retatrutide for obesity has been tested in a phase 2 trial, funded by eli lilly and published in the new england journal of medicine in june 2023 . on average, adults with obesity and overweight lost up to 17.5 per cent within 24 weeks of the treatment. the additional metabolic health measures, such as blood pressure, cholesterol and insulin also improved. the authors note that in a prior phase 1b trial with participants living with type 2 diabetes, retatrutide treatment resulted in a mean weight reduction of about 10 per cent in the highest-dose group after 12 weeks.

as research has shown, the most important factor in achieving remission for people with type 2 diabetes is weight loss. the  diabetes remission clinical trial known as direct , conducted in primary care practices in the uk, examined type 2 diabetes remission rates in participants who lost weight and sustained the weight loss over time. direct found high rates of type 2 diabetes remission among people who lost a significant amount of weight – about 22 pounds – and sustained the weight loss over 12 to 24 months.

implantable devices for more convenience

celanese corporation is developing an implantable device that delivers one or more glp-1 receptor agonists so that continuous dosage can be easily managed. glp-1 treatments can last months and years, and otherwise require frequent injections or daily pills. intarcia therapeutics, however, designed a miniaturized glp-1 implant to slowly release the type 2 diabetes medication exenatide over the course of six months that was turned down in 2023 by the u.s. food and drug administration’s committee of outside advisers. another competitor, vivani medical, has announced it will begin human trials of its six-month glp-1 implant for chronic weight management in obese or overweight patients with a related comorbidity like type 2 diabetes.

double receptor agonists to manage side effects

novo nordisk’s cagrisema, a combination therapy with 2.4mg semaglutide and 2.4mg cagrilintide, an amylin analog, is currently in the phase 3 clinical trial. the novel therapy has been shown in the american college of cardiology journal in 2023 to promote substantial weight loss with fewer side effects compared to semaglutide and cagrilintide alone.

cost, access, side effects and the future of glp-1 treatments

glp-1 obesity therapies have already  generated billions in sales .  globaldata has estimated  that glp-1 receptor agonist sales for the type 2 diabetes and obesity markets will reach more than us$125 billion in 2033.

and although these drugs are promising and effective tools for physicians, there are concerns over cost, access, frequency of injections, and side effects like the nausea, stomach pain and heartburn that can happen with wegovy, for example. medicines in the same class as wegovy and ozempic, with the active ingredient semaglutide, may increase the risk of pancreatitis, intestinal blockage and stomach paralysis compared to an older obesity drug with the active ingredient liraglutide, a study published in the jama medical journal in october 2023 found . so, news of r&d in the pharmacy industry is notable, and the coming wave of lower-cost generic alternatives to the current meds on the market could offer flexibility of treatment, like higher doses to be used in the acute phase to help patients shed pounds, followed by lower maintenance doses on a less frequent schedule.

as wharton says, there’s much more work to be done in obesity medicine to promote understanding of the condition and advance therapies. “we don’t always have the biological and the scientific answer. i don’t really know all the scientific aspects of obesity or the visceral adiposity (body fat deep in the abdomen) or the brain neurochemistry. because we’re not there yet.”

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