ObesityWeek Roundup: Patients More Likely to Ration Obesity Drugs

SAN ANTONIO — Research presented at the ObesityWeek annual meeting included studies on rationing of prescription medications among adults with obesity, weight loss results with 25 mg of oral semaglutide, and risk reduction of hypertension in teens taking GLP-1 receptor agonists.

Adults With Obesity More Likely to Ration Drugs to Save Money

Adults with obesity are more likely to ration their prescription drugs to save money compared with adults without obesity, according to an analysis of federal survey data.

The prevalence of cost-related prescription drug rationing was 8.3% among adults with obesity versus 5.9% among those without obesity (P<0.001), reported Alissa S. Chen, MD, MPH, of Yale School of Medicine in New Haven, Connecticut. The findings were also published in a research letter in JAMA Network Open.

In addition, adults with obesity and cardiovascular disease (CVD) had higher prevalence of rationing than those without CVD (10.3% vs 8%, P=0.005).

Nearly 80% of adults find the cost of prescription drugs to be unreasonable, and the high cost of GLP-1 receptor agonists could exacerbate pre-existing prescription rationing since not all insurers cover them, Chen said. Prescription rationing has particularly important implications for health equity since a higher proportion of Black (50%) and Hispanic (45%) adults have obesity compared with white (42%) and Asian (17%) adults.

In this study, white adults with obesity had a lower prevalence of rationing medications (7.7%) compared with Black adults (9.8%) and Hispanic adults (10.7%). Younger adults (ages 18-44) and female respondents were also more likely to ration medications.

“The implications for this are that structural barriers impede access to medications for Black and Hispanic adults with obesity, which might worsen if there’s not expanded coverage for GLP-1’s, and it’s possible that broader insurance coverage could ameliorate some of these issues,” Chen told attendees.

For this study, the researchers analyzed data on non-pregnant adults surveyed by the National Health Interview Survey from 2020-2022. They included all respondents who took prescription medications and answered all questions about drug rationing, but they excluded respondents with diabetes to avoid including those who were potentially taking GLP-1 medications or rationing insulin. The respondents were asked whether they had skipped medication doses, taken less medication, or delayed filling a prescription to save money during the previous 12 months.

Of the 51,720 respondents, 33.9% had obesity, defined as a body mass index (BMI) of at least 30. Mean age was 51.2, 58.4% were women, 80% were white, 9.7% were Black, 9.7% were Hispanic, and 4.4% were Asian.

Oral Semaglutide Meets Endpoints at Lower Dose

A once-daily 25-mg oral dose of semaglutide resulted in greater weight loss and improved physical function and cardiometabolic measures compared with placebo, the randomized OASIS 4 trial showed.

Participants taking oral semaglutide lost an average 13.6% of their body weight at 16 months, while placebo participants lost an average 2.2% (P<0.0001) in an intention-to-treat analysis, reported W. Timothy Garvey, MD, of the University of Alabama at Birmingham.

At 64 weeks, 79.2% of semaglutide participants and 31.1% of placebo participants had lost at least 5% of body weight (OR 7.3, 95% CI 4.2-12.8, P<0.0001). More semaglutide participants also lost at least 10% (63% vs 14.4%; OR 9.1, 95% CI 4.7-17.3, P<0.0001), 15% (50% vs 5.6%; OR 15.7, 95% CI 6.2-40.2, P<0.0001), and 20% (29.7% vs 3.3%; OR 12.2, 95% CI 3.7-40.3, P<0.0001) of their body weight at this time.

Oral semaglutide 25 mg is not currently FDA-approved for weight management. A 7-mg and 14-mg dose of oral semaglutide is currently approved for type 2 diabetes under the name Rybelsus.

“The availability of oral GLP-1-based medications offers patients a choice for those who would prefer orals to injectables,” Garvey told MedPage Today. “Persistence on medication is lacking regarding obesity medications, and oral preparations would predictably be associated with greater longer-term adherence in many patients.”

The previous phase III OASIS 1 study showed that 50 mg of oral semaglutide once a day resulted in an average 15.1% loss of body weight compared with a 2.4% loss with placebo.

“There is a principle in medicine that you always use the lowest dose that is effective,” Garvey said. “In the case of oral semaglutide for overweight/obesity, it appears that 25 mg a day is that dose.”

The trial enrolled 243 participants with a BMI of at least 30, or 27 with a weight-related comorbidity, at sites in Canada, Germany, Poland, and the U.S. Mean age was 48 years, 78.8% were women, and 91.5% were white; mean BMI was 37.6.

Participants were not included if they had an HbA1c level of at least 6.5% or if they had lost at least 5 kg of their body weight within 90 days before study screening.

The 167 participants in the semaglutide group started at 3 mg, which escalated up to 25 mg at 12 weeks. Both groups underwent a lifestyle intervention program that involved consuming 500 fewer calories per day and at least 150 minutes of physical activity per week.

The estimated change in Impact of Weight on Quality of Life (IWQOL)-Lite-Clinical Trials version physical function score was 16.2 for the semaglutide group versus 8.4 for the placebo group at 64 weeks (P=0.0006). In addition, 55.3% of semaglutide participants reported a clinically meaningful increase in physical function score compared with 34.8% of placebo participants (P=0.002).

Semaglutide participants also reported greater decreases in C-reactive protein (-46.4 vs -4.2, P<0.0001), HbA1c (-0.29% vs -0.06%, P<0.0001), and triglyceride levels (-18.4 vs -7.5 mmol/L, P=0.014).

Among the 129 participants who had prediabetes at baseline, 71.1% of semaglutide participants and 33.3% of placebo participants achieved normoglycemia.

The most common adverse events with semaglutide were nausea (46.6%), vomiting (30.9%), and constipation (20.1%); 3.4% of semaglutide participants discontinued the trial due to gastrointestinal side effects compared with 2% of placebo participants.

GLP-1 Medications Linked to Reduced Hypertension Risk in Teens

Adolescents with obesity who took a GLP-1 receptor agonist were half as likely to develop hypertension over the next decade compared with those who took other anti-obesity medications, according to a retrospective analysis of a national electronic medical records database.

At 5 years after starting an anti-obesity medication, 2.12% of adolescents taking GLP-1 medications and 3.96% of those taking another anti-obesity medication developed hypertension (risk ratio [RR] 0.54, 95% CI 0.36-0.81), reported Shradha Chhabria, MD, MPH, of University Hospitals Cleveland Medical Center and Rainbow Babies and Children’s Hospital at the Case Western Reserve University School of Medicine in Cleveland.

At 10 years, 2.12% and 4.08% developed hypertension, respectively (RR 0.52, 95% CI 0.35-0.79).

An estimated 20% of U.S. adolescents have obesity, and about one in four have diagnosed hypertension, which increases their risk of morbidity and mortality, Chhabria said.

“The existing literature clearly shows efficacy of treating obesity itself, but our study contributes to the evidence by also supporting the superiority [of GLP-1 medications] over other anti-obesity medications in preventing the development of obesity-related comorbidities over the long term,” even though this study cannot show causality, Chhabria said.

The researchers analyzed data from the TriNetX database to examine incident hypertension in adolescents with obesity at 5 and 10 years after initiation of either GLP-1 medications or other anti-obesity medications.

They used propensity matching to compare 1,925 adolescents who took semaglutide (Wegovy), liraglutide (Saxenda), dulaglutide (Trulicity), or tirzepatide (Zepbound) to 1,923 adolescents who took any of the following: bupropion, phentermine, topiramate, naltrexone, orlistat (Xenical, Alli), or metformin.

Mean participant age was 15, and 61% were female. Mean BMI was 41.7 in the GLP-1 group and 37.9 in the other group. Nine percent of both groups had type 2 diabetes, and similar proportions had high cholesterol, metabolic dysfunction-associated steatohepatitis (MASH), a different fatty liver condition, thyroid disease, and obstructive sleep apnea.

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