Doctors challenge sustainability of weight loss medicines for long-term outcomes

Pharma News: Dr Michael Bonning, general practitioner and President of the Australian Medical Association (AMA) in New South Wales, has shed light on the crucial intersection of weight loss and medication cessation.

Obesity has nearly tripled since 1975 to a staggering 650 million adults globally in 2016, with 31% of the population affected in Australia. As the second leading contributor to nation’s burden of disease, obesity brings with it a host of complications, including cardiovascular disease, type 2 diabetes, chronic kidney disease, fatty liver, obstructive sleep apnoea, and various cancers.

Several GLP‐1 receptor agonists are available in Australia for the treatment of type 2 diabetes, of which Lilly’s Mounjaro (tirzepatide) and Novo Nordisk’s Wegovy (semaglutide) are also indicated for obesity treatment at higher doses. Wegovy is now the first weight loss medicine to be approved (US FDA) for reducing the risk of cardiovascular death, heart attack and stroke in patients with cardiovascular disease and obesity as supported by the SELECT clinical trial data.

Clinical trials have shown that maximal weight loss with GLP-1 drugs is not achieved until about one year, with about 6% weight loss achieved within 12 weeks. However, questions arise about the sustainability of these drugs and the implications of discontinuation.

A global perspective on GLP-1 drugs reveals an unexpected challenge – a shortage driven by the very success of these medicines which raises concerns about patient adherence and persistence in the face of limited availability.

Findings from international trials reveal that participants withdrawing from once-a-week treatment with Wegovy experienced a regaining of more than half the lost weight within a year. Similarly, individuals discontinuing Mounjaro faced a 60% weight regain.

Adherence to treatment is also a challenge. One‐year treatment discontinuation rates in clinical trials are 17 – 50% for medications currently approved for long term weight management, but persistence with treatment is much lower (< 10%) in real‐world studies, according to a recent Australian review.

“The Australian Medical Association has a comprehensive approach to physical activity, food standards reform, built environments and social structures that describes a better future for health. With increasing rates of obesity and diabetes strongly linked, we need to make significant changes to avoid a future that is ultimately hazardous to health,” said Dr Bonning.

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