victoza

The first 2024 episode of HR Benecast features Courtney Keefe, Employers Health's resident GLP-1 expert. She'll share utilization, discontinuation and coverage trends for GLP-1s and anti-obesity drugs. Listeners will hear the latest on anti-obesity drug coverage under the pharmacy benefit, new drugs in the pipeline and how the big PBM's are managing drugs like Wegovy, Mounjaro and Zepbound. 

In this episode, Dr. Christopher Tookey and Dr. Rose Wolbrink go through some common misconceptions patients may hear about with regards to some of the new weight loss medications everyone is talking about. This episode is focused on the injectable medications called GLP-1 agonists. Examples inculde Saxenda, Ozempic, Wegovy, Trulicity Mounjaro and Byetta 

A disclaimer, we're providing general guidance but everyone is different and you should always discuss with your health care professional management of any disease and therapy before trying anything you discover from a source on the internet (including this podcast) 

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/

Last week we reviewed the traditional weight loss medications that were used commonly before this very effective new class of weight loss drugs. Like most medications, drug companies’, researchers and doctors find amazing new drugs for a use that the drug was never intended for.  An example of this is the drug Viagra.  It was initially being presented to the FDA as a blood pressure and cardiac drug.  It increased nitric oxide and that dilates arteries, which lowers blood pressure and eases the work on the heart.  On the pathway to approval, they found that Viagra was the first drug discovered that could create an erection in men who were important.

In 2010 a drug-group called GLP-1 receptor agonists was introduced as a treatment for diabetes.  This class of drug, much like Viagra, was found to induce loss of fat, while preserving muscle mass resulting in weight loss.  The first drug name was Victoza (liguride), and after the weight loss aspect of this drug was confirmed, the weight loss drug was named Saxenda. These drugs are injectable only but are subcutaneous delivered with a “pen” and are extremely effective for weight loss.

If a patient doesn’t have a problem with injecting a subcutaneous medication every day, then this drug has it all!  GLP-1 RAs causes weight loss 3 ways: 1) They decrease hunger, 2) they cause patients to feel full when they eat half as much as usual, and they 3) speed up their overall metabolism so they burn more calories at the same level of activity.  These drugs can also be continued for life if necessary to maintain a healthy weight.

These drugs are perfect for pre-diabetics, and Adult-Onset Diabetics (AODM), because not only is weight loss successful but insulin resistance is treated with this medication.  As usual, with any excellent answer to a problem, we are limited in its use by the cost of this medication.   For those people who need to lose weight and can go on it for 6 months or less to achieve their goal, it is still unaffordable.  There is no way to write a script for this medication and expect a patient to pay $667-928/month, and unless they have diabetes insurance will not generally pay for this drug.  The side effects from Liguride may also be a reason it can’t be used by everyone.  Patients who have GI reflux, Barret’s esophogus, or GI ulcers can’t take this drug because it slows the emptying of the stomach and makes these conditions worse.

Prior to 2010, Metformin ER had been used for the treatment of pre-diabetes, AODM, and Insulin resistance for years, and has been effective for weight loss in many patients who have these conditions as the reason for their obesity.  Metformin ER is inexpensive and is paid for by insurance, unlike all the other weight loss drugs, because it is also used for diabetes. In my practice, for patients with IR, AODM, hypertension, and heart disease who need to lose weight

This is a very safe and effective way to lose weight, but it only works when a patient follows a low carb diet, and daily exercise to be truly effective.  Metformin literally makes my patients healthier and is considered one of the most effective anti-aging medicine available.

Another rather new combination of drugs used for weight loss is Naltrexone/Bupropion is not one that I have used in the office because of the high risk of side effects. I suspect in other medical hands it can be effective.

The newest drug, Semaglutide, sold under the name of Ozempic and Rybelus, is extremely effective  and is given as a subcutaneous shot that can be self-administered once a week so compliance is not a factor. Rybelus must be taken daily but is a pill and not an injection, so is good for those with needle phobia.   Semaglutide in either form stops hunger, makes my patients feel full, and increases the speed of metabolism so they burn more calories than other people at the same level of exercise.  Ozempic/Rybelus can be given to patients who are not candidates for amphetamines and who have reflux side effects from Victoza/Saxenda.

Ozempic/Rybelus is well tolerated and can be given to anyone who will give themselves a shot once a week.  The only problem with this medication is the cost, 4-6 weeks costs $900-$1200. We have found a way around this for those patients who can’t afford this price and have gotten it down to about $500/2 months.  If you think about it, you can be very compliant and not use it very long to get to your ideal weight, then you would only have to use the drug for a short period of time.  We have achieved a great weight loss for our patients when we manage their diet, exercise, and replace testosterone with pellets if they are over 40, by seeing them in the office every month until they achieve their ideal weight.

We always recommend a low carb diet, keeping a diary of food, water and daily exercise in My Fitness Pal app, which makes all of these treatment methods more successful than the experts claim. There is no weight loss that lasts without dieting and exercise, even with medication.

Taking a drug to lose weight is your chance to change your lifestyle so that you can keep the weight off after you stop the medication. You have to be completely on board to actually succeed at achieving your ideal weight….and staying there.

Talk to your doctor about these drugs …but only if you are ready to change your lifestyle for the better..you must be all in to get healthy for life!