A Promising Weight-Loss Aid Emerges: Diabetes Drugs

A Promising Weight-Loss Aid Emerges: Diabetes Drugs

Subjects in one study lost up to 22.5% of their body weight after nearly 18 months of treatment

By Peter Loftus, WSJ

June 21, 2022 11:01 am ET

Drugmakers have found powerful new tools to help overweight people shed pounds by tapping into treatments for another disease: diabetes.

Eli Lilly and Co., Novo Nordisk A/S and others have begun selling or are testing drugs that help treat both conditions, which often overlap in individuals and together affect hundreds of millions of people globally.

The drugs are effective for both diabetes and obesity because they promote production of hormones in the body that tell people they are full after eating and stimulate insulin secretion, in turn lowering blood-sugar levels, doctors and the companies say.

A new study showed that an Eli Lilly drug, tirzepatide, helped obese people who didn’t have diabetes lose up to 22.5% of their body weight after nearly 18 months of treatment. Indianapolis-based Lilly is conducting additional studies of tirzepatide for weight loss before it can submit the drug for regulatory approval for that use, potentially next year.

Doctors say the dual-purpose drugs appear to be among the most effective and safest pharmaceutical options for people who are overweight or obese. Some older diet drugs had serious safety concerns or modest efficacy, which together with spotty insurance coverage limited their use among patients.

“It’s a whole new world,” said Thomas Wadden, a professor of psychology at the University of Pennsylvania’s Perelman School of Medicine, who previously led Penn’s weight-loss center. “It’s exciting from the standpoint of patient satisfaction and changes in quality of life.”

Novo Nordisk launched Wegovy last year, a drug in a class known as glucagon-like peptide 1, or GLP-1, agonists. They work by mimicking natural hormones that stimulate the release of insulin and help suppress appetite.

Lilly’s tirzepatide promotes both GLP-1 and a second hormone, called glucose-dependent insulinotropic polypeptide, or GIP. Promoting GIP was shown in animal studies to decrease food intake and increase energy expenditure, resulting in weight reductions.

“We know from a lot of research these hormones are involved not just in the regulation of glucose in the body, but also in the regulation of energy balance,” said Nadia Ahmad, Lilly’s medical director of the tirzepatide obesity program.

The advances could mean big sales for drugmakers. Sales of Novo’s obesity drugs more than doubled to about $480 million for the first three months of 2022, helped by the launch of Wegovy. Novo expects annual anti-obesity drug sales to reach more than $3.5 billion by 2025.

J.P. Morgan analysts predict that Lilly would generate peak annual sales of $10 billion for tirzepatide’s use in obesity alone, if it is approved for that use. Together with its use in Type 2 diabetes, the analysts predict total peak annual sales of $25 billion for the drug.

The expected sales boom is partly driven by the rising number of people with diabetes and obesity. More than 40% of American adults, or about 100 million, meet the criteria for obesity of a body-mass index of 30 and above, according to the National Institute of Diabetes and Digestive and Kidney Diseases. More than 30 million Americans have Type 2 diabetes.

“Obesity is rampant in modern culture and anything we can do to reduce rates of obesity will help patients, will help public health and reduce healthcare spending,” said Katherine Tuttle, executive director for research at Providence Health Care in Spokane, Wash. Dr. Tuttle has served as an investigator in some Lilly clinical trials of tirzepatide and another drug.

The drugs carry high prices—a downside for patients who still face spotty insurance coverage. Novo’s Wegovy has a list price of about $1,300 a month. Many patients are on insurance plans that don’t pay for the drug or require high out-of-pocket costs. And the federal Medicare drug benefit doesn’t cover Wegovy.

Lilly’s tirzepatide was approved in May in the U.S. to treat Type 2 diabetes, under the brand Mounjaro, and has a list price of $974 a month. Lilly said it is too early to speculate on pricing if the drug is cleared for weight loss.

Wegovy, a once-weekly injection, has been in high demand since it was approved for weight management by the Food and Drug Administration in June last year, compounding a supply shortage in the winter when a contract manufacturer had quality issues. Wegovy has the same active ingredient, semaglutide, as Novo’s Type 2 diabetes treatment Ozempic, which the FDA approved in 2017 for Type 2 diabetes.

Studies have shown Wegovy can help people lose about 15% of their body weight on average, and keep it off as long as patients continue to take it.

Denmark-based Novo has been trying to persuade more drug-benefit plans in the U.S. to cover the drug by emphasizing that obesity increases people’s risk for other diseases including diabetes, said Camilla Sylvest, Novo’s executive vice president of commercial strategy and corporate affairs.

For Qamara Edwards, 40, concerns from her doctor about her weight and risk of developing Type 2 diabetes led her to enroll in a clinical study of Wegovy at Penn in 2018. The director of events for a Philadelphia restaurant group, she had previously made attempts at losing weight through diet and exercise, with inconsistent results.

At first, she didn’t know whether she had received the actual drug or a placebo in the study. But eventually she noticed having a smaller appetite and feeling full after eating smaller portions. “My clothes were getting baggy, and I was able to physically drop sizes,” she said.

By the end of the study in late 2019, Ms. Edwards had lost about 75 pounds, she said.

She regained much of the weight, however, after she stopped taking Wegovy, when the study ended and it still wasn’t approved for use. When Wegovy was approved in 2021, her insurance plan didn’t cover it and she found it too expensive. Now she is enrolled in another study of a once-daily pill formulation of Wegovy, and has lost weight again.

“Some people need assistance for weight loss,” Ms. Edwards said. “Some people’s bodies are made in a way where they could go to the gym forever and it still wouldn’t matter.”

These drugs aren’t without side effects. They can cause gastrointestinal issues like diarrhea and nausea. Doctors say these effects are most common at the start of treatment when doses are being escalated, and usually subside.

Qamara Edwards, who works at a Philadelphia restaurant group, has been losing weight again as a participant in a clinical trial of Wegovy in pill form.

PHOTO: CAROLINE GUTMAN FOR THE WALL STREET JOURNAL

Write to Peter Loftus at peter.loftus@wsj.com