Today I focus on GLP 1 agonists- most notably semaglutide also known as Ozempic or Wegovy and Tirzepatide also known by the brand name Mounjaro.
These weight loss drugs are all the rage right now. Not a day goes by that I don’t get asked my thoughts on them.
What are they, what are their differences and how are they marketed, how they first came to be used as diabetes drugs and what do we know about them clinically?
Why are people so excited about these drugs? There are two hormones we are talking about today- GLP-1 or glucagon like peptide 1, and GIP or glucose dependent insulinotropic polypeptide. Both of these are hormones that are released from the gut. These drugs were originally developed to take care of patients with type 2 diabetes. Type 2 diabetes is a disorder of carbohydrate metabolism or in other words, Insulin resistance. The cells, most importantly muscle cells, become resistant to the effect of insulin, and as a result, the blood glucose levels rise . Muscle is the most important storage for glucose. If the muscle is resistant to effects of insulin , glucose will accumulate in the blood stream.
One role of GLP 1 is to prompt the body to stimulate release of more insulin. But GLP 1 , in higher amounts, also interacts with the areas in the brain that suppresses appetite and signals us to feel full. When used in conjunction with diet and exercise, Semaglutide can cause significant weight loss in addition to reducing the risk of cancer, diabetes and heart disease- in people who are overweight or obese.
It’s important to remember that obesity is a chronic, complex and heterogenous disease that has no cure. It requires lifelong treatment that’s not one size fits all. It’s easy to see why GLP 1 agonists are all over news and social media outlets. There has not been this much excitement with any new drug for obesity in a while. Most of the patients reaching out do not have type 2 diabetes , but are reaching out solely through the lens of weight loss. While some patients do need the medication to achieve weight loss, others are not remotely overweight, but want to lose 10 lbs to look good for their next vacation. These are likely not the right type of patient population for using these drugs.
Semaglutide is a pure GLP 1 agonist. The branded name for Semaglutide that is used for type 2 diabetics is Ozempic. It comes in three doses- 0.5, 1 and 2 mg weekly. These are auto injector pens that need to be refrigerated. Ozempic was approved to treat type 2 diabetes in late 2017. In June 2021- Semaglutide received the indication of treating obesity without diabetes. This led to the approval of Wegovy which is the exact same drug Semaglutide. The difference is branding and dosing. Wegovy is dosed up to 2.4 mg per week, injected subcutaneously. This semaglutude is Ozempic is Wegovy. Confusing, but the difference is in the branding and dosing.
FDA recommends Semaglutide or branded Wegovy for weight loss if you meet one of the
following criteria-
- Have a body mass index or BMI of 27 or greater, and at least one weight-related
condition such as high blood pressure, diabetes or high cholesterol - Have a body mass index or BMI of 30 or greater.
Tirzepatide is both GIP and GLP 1 and is branded as Mounjaro.
- Preloaded pen 2.5 mg all the way up to 15 mg.
- Recently approved for type 2 diabetes. It has not yet gained approval for weight loss.
- Presumably it is in the process of gaining FDA approval for treatment for obesity.
In the next blog, I will discuss the side effects and precautions with the use of semaglutide.
