Weight Loss Drugs
History
Over many years, drugs have been developed and sold for weight loss and that continues to the present day. A closer look at this highlights that anti-obesity drug discovery programmes have been littered with false starts, failures in clinical development and withdrawals due to adverse effects that were not fully appreciated at the time of launch.
One such drug was Lorcaserin, marketed as Belviq and developed by Arena Pharmaceuticals. It reduced appetite by activating a type of serotonin receptor known as the 5-HT2C receptor in a region of the brain called the hypothalamus, which is known to control appetite. Approved for use in 2012, by 2020 it was removed from the market in the United States due to an increased risk of cancer detected in users of Belviq. The FDA concluded that the drug’s purported benefits did not outweigh its risks for any identifiable patient population.
More recently in July 2023, an expert panel of the World Health Organisation (WHO) recommended against including drugs for weight loss on their latest essential medicines list , citing the uncertain long-term clinical benefit and safety in this patient population.
latest hope
Glucagon-like peptide-1 (GLP-1) receptor agonists (RA) would seem to be the “new hope” in this field so worth examining further. This includes semaglutide, also known as Ozempic or Wegovy (“so good, they renamed it twice”?)
These drugs mimic the action of GLP-1 hormone so when blood sugar levels start to rise after eating, they stimulate the body to produce more insulin which helps lower blood sugar levels, explaining why they are used to control type 2 diabetes. They also appear to help curb hunger. Whilst that isn’t fully understood, they seem to slow the movement of food from the stomach into the small intestine so you may feel full faster & longer and so eat less.
Just over a year ago, in rightly recognising that weight management is one of the biggest challenges the UK health service is facing with nearly 66% of adults either overweight or obese, the National Institute for Health and Care Excellence (NICE) issued draft guidance recommending semaglutide. It stipulated it’s use just for adults with at least one weight-related condition and a body mass index (BMI) of at least 35 kg/m2, and exceptionally, to people with a BMI of 30.0 kg/m2 to 34.9 kg/m2.
Even our former UK Prime Minister Boris Johnson tried Ozempic for a few weeks and is reported to have lost four or five pounds a week
......before he stopped because it made him feel ill. Boris is certainly not alone in stopping such drugs as most do within a year for several reasons including reaching what’s known as the “Ozempic plateau”, with about two-thirds of their weight re-gained within a further year.
Clearly the stipulated limitation on the use of GLP-1s is primarily related to their high cost with upwards of 16,000 US dollars per person per year reported.
serious side effects
But, more important to me than the very high cost, the reported side effects include some very serious ones. For example, the risk of muscle-loss known as sarcopenia, the process by which the aging physique marches toward frailty, falls and even death. This was reported by a prominent US doctor and non-prescriber of weight loss drugs on medical grounds. And I’m afraid that the seriousness of side effects doesn’t end there and may even worsen.
For brevity, only an overview of some of the more serious, reported side effects is now given:
Scientists have been advising caution with semaglutide for patients with moderate to severe chronic kidney disease due to their limited reserve in the reportedly more likely event of an acute kidney injury.
Gastrointestinal problems are widely reported side effects of GLP-1s and now users are even reporting that their stomachs are paralysed.
A few months ago, it was reported that the European Medicines Agency’s safety committee is reviewing data on the risk of suicidal thoughts and thoughts of self-harm with users of GLP-1s. And this effect is now much more widely reported within the medical field.
One of the cancer types that has been associated with GLP-1s is thyroid cancer. For example, a scientific article published in a journal of the American Diabetes Association found increased risk of all thyroid cancer and medullary thyroid cancer with use of GLP-1s.
Acute pancreatitis is a serious condition that may have a fatal outcome. After eliminating other common causes of this condition for a medical case, medical scientists concluded that acute pancreatitis can be considered a side effect of GLP-1 treatment. And with a strong link between chronic pancreatitis and subsequent development of pancreatic cancer, maybe it’s no surprise to find report(s) that a pharmacovigilance study found an association between that extremely serious condition and GLP-1s.
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Disclaimer:
This blog has been compiled in good faith for educational purposes. It also includes references to other information provided by relevant organisations sourced via the internet and my related interpretation. Whilst every effort has been made to ensure the accuracy of the above, I cannot accept liability for any unknown errors, omissions or misinterpretation of the information.
The information provided is not a substitute for professional medical advice which can be sought from a medical professional or other healthcare provider.
