Latest / Morning Medical with Dr. Chow / Tirzepatide Advancements, GLP-1 Controversies, and Nasal Spray Epinephrine Breakthroughs

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Tirzepatide Advancements, GLP-1 Controversies, and Nasal Spray Epinephrine Breakthroughs · Morning Medical with Dr. Chow

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  Good morning, everyone, and welcome to another episode of Morning Medical with Dr.
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  Chow.
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  I am Dr.
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  Chi-Ming Chow, your host, and today we are diving into some fascinating new research that
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  promises to reshape our understanding of weight management and diabetes prevention.
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  Let's get started with some promising news from Eli Lilly.
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  The drug tirzepatide, which has gained popularity for its treatment of Type 2 diabetes
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  and weight loss, has been found to lower the risk of progression to diabetes by a staggering
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  94 percent among adults with prediabetes and obesity or who are overweight.
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  This is according to a new study by the drugmaker Eli Lilly.
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  While the study has not yet been peer-reviewed, experts who spoke with Global News say the data
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  suggests the possibility of significant risk reduction over the coming years.
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  The results of this three-year study, involving the drug also known by its brand names Mounjaro
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  and Zepbound, were released on Tuesday.
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  The report shows that weekly injections of any of the three dosage amounts—five, ten, and
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  fifteen milligrams—significantly reduced the risk of progression.
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  Participants also saw sustained weight loss.
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  Those on the highest dose of 15 milligrams experienced an average decrease in body weight
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  of 22.9 percent compared to just 2.1 percent among those who took a placebo during the
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  study’s treatment period.
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  Dr.
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  Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and
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  Women’s Hospital in Boston, emphasized the importance of this finding.
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  She said, 'It is highly significant that this study showed that in those people who had
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  prediabetes.
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  That is a major risk reduction in development of Type 2 diabetes.' It’s important to note
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  that Dr.
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  Apovian had no involvement in the study nor with Eli Lilly.
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  Mounjaro, which has also been approved for use in Canada, is primarily used for diabetes
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  treatment.
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  However, like its sibling Zepbound, it has also received approval for weight-loss use.
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  Zepbound was approved last year in the United States for people considered obese, with a body
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  mass index of thirty or higher, and those who are overweight with a related health condition,
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  like high blood pressure or diabetes.
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  The Food and Drug Administration recommends pairing the drug with a healthy diet and
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  regular exercise.
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  Dr.
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  Tom Elliott, medical director of BC Diabetes, highlighted the importance of maintaining
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  muscle strength while on these medications.
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  'Weight loss is not entirely good; you need to maintain one’s strength,' he told Global News.
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  'So it’s very important to avoid loss of lean muscle, so that means getting into the gym,
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  having some home weights, making sure our muscles are stronger than ever.'
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  Tirzepatide works by mimicking hormones that kick in after people eat to regulate appetite
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  and the feeling of fullness.
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  It imitates the hormones glucagon-like peptide-1, known as GLP-1, and
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  glucose-dependent insulinotropic polypeptide, or GIP.
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  Eli Lilly reports that the overall safety and tolerability of the drug during the study were
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  consistent with previously published studies conducted for chronic weight management.
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  Side effects like diarrhea, nausea, constipation, and vomiting were the most
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  commonly reported, but the company noted that these adverse events were generally mild to
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  moderate in severity.
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  Dr.
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  Apovian pointed out that these relatively minor adverse events indicate the safety of drugs
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  like tirzepatide, saying, 'The safety comes from the fact that they are analogs of
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  naturally occurring hormones.
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  We understand a lot about the cause of obesity to be able to produce a treatment that can
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  physiologically get people to a healthier body weight and still be safe.'
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  The study was conducted over 176 weeks among 1,032 adults who had prediabetes at random and
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  were either obese or overweight.
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  This was followed by a 17-week off-treatment period.
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  However, this off-treatment period did raise some concerns, as participants began to regain
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  weight during that time.
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  Despite this, there was still an 88 percent lower risk of developing diabetes compared to
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  those taking the placebo.
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  Dr.
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  Elliott mentioned that maintaining weight loss and preventing diabetes does not come solely
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  from taking tirzepatide or similar drugs.
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  'It does require discipline,' he said.
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  'If you’re not going to work hard on the fundamentals of eating less and exercising
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  more, then if you come off one of these drugs, Ozempic or Mounjaro or whatever the new flavor
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  is, you will regain weight and lose what advantage you’ve gained.' Dr.
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  Elliott disclosed he has been involved in clinical trials for Eli Lilly over the past 20
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  years.
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  The possibility of regaining weight may raise the question of whether one has to remain on a
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  drug like tirzepatide for life to avoid weight gain.
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  Dr.
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  Apovian offered some perspective on this, saying, 'The good news is if you’re on
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  tirzepatide lifelong, you may not have to be on other medications for blood pressure, diabetes,
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  or heart disease.
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  So that’s the whole point.'
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  The results of this study will be submitted to a peer-reviewed journal and presented at the
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  ObesityWeek medical conference in November.
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  This could be a landmark moment in the field of weight management and diabetes prevention.
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  Stay tuned as we continue to monitor these developments.
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  Let's turn our attention to a new study that has reignited safety concerns about a popular
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  weight loss drug.
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  This study, published in the journal JAMA Network Open, suggests that people taking
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  semaglutide, the medication sold under the brand names Ozempic and Wegovy, may be more
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  likely to report having thoughts of suicide compared to those taking other drugs.
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  Semaglutide has been widely used for both diabetes and weight loss, and it has shown
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  promising effects, including reductions in kidney disease and cancer.
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  However, the new study, which analyzed an international drug safety database maintained
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  by the World Health Organization, found 107 reports of suicidal thoughts among more than
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  30,500 semaglutide users.
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  In comparison, there were 162 similar reports among over 52,000 users of liraglutide, another
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  drug in the same class.
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  The study authors noted what they described as a disproportional risk of suicidal thoughts in
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  people taking semaglutide but not in those taking liraglutide.
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  Specifically, the risk of suicidal thoughts was elevated by about 45 percent in people taking
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  semaglutide compared to those taking other drugs in the database.
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  This risk was notably higher—approximately four times—in individuals who were also on
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  medications to control depression and anxiety, suggesting that this group might be at an even
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  greater risk for mood-related side effects.
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  When the researchers excluded cases of individuals taking both semaglutide and
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  antidepressants, the association between semaglutide and suicidal thoughts disappeared.
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  This implies that the elevated risk may be driven by those who were taking both types of
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  medications.
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  Despite these findings, the study authors acknowledge that their research has limitations
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  and that more investigation is needed to clarify the risk.
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  It's worth noting that health regulators, including the European Medicines Agency and the
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  United States Food and Drug Administration, have not found conclusive evidence linking
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  semaglutide to an increased risk of suicide.
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  The FDA's ongoing investigation has not identified a significant increase in risk,
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  although the agency cannot entirely rule out a small increase due to the limited number of
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  events in their surveillance systems.
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  Previous research has also yielded conflicting results.
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  For instance, a large study published earlier this year in the journal Nature Medicine found
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  that semaglutide was linked to a lower risk of suicidal thoughts compared to other weight loss
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  and diabetes medications.
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  This highlights the complexity and the need for more comprehensive studies to determine the
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  drug's safety profile fully.
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  Experts have weighed in on the new study, offering varied perspectives.
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  Dr.
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  Mahyar Etminan, an expert in drug safety at the University of British Columbia, pointed out
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  that it is challenging to determine whether the drug or the underlying mood disorder is
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  responsible for the observed effects.
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  Ian Douglas, a professor of pharmacoepidemiology at the London School of
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  Hygiene & Tropical Medicine, echoed this sentiment, stating that the study presents weak
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  evidence of an association between semaglutide and suicidality.
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  In a commentary on the study, two French drug safety researchers, Dr.
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  Francesco Salvo and Dr.
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  Jean-Luc Faillie, emphasized the need for caution.
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  They noted that conclusions from drug safety studies often vary depending on the database
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  and methods used.
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  They recommend that GLP-1 and other appetite suppressants be prescribed cautiously for
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  individuals with a history of depression or suicidal thoughts.
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  Additionally, they suggest that doctors consider discontinuing the medication
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  immediately if patients experience new episodes of depression while on the drug.
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  This study underscores the ongoing debate and the importance of continued research into the
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  safety of weight loss medications like semaglutide.
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  As always, patients should consult with their healthcare providers to carefully weigh the
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  benefits and risks before starting any new medication.
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  Worried about your type 2 diabetes risk?
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  You might want to look at the kinds of meat you are eating, according to a new study.
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  Regularly eating red and processed meats in particular is associated with a higher risk of
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  type 2 diabetes, according to an analysis of data from 31 study cohorts published Tuesday in
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  the journal The Lancet Diabetes and Endocrinology.
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  The study is the most comprehensive to date showing the link between processed meat and
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  unprocessed red meat with type 2 diabetes, said senior study author Dr.
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  Nita Forouhi, professor of population health and nutrition at the University of Cambridge in
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  the United Kingdom, in an email.
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  Type 2 diabetes, a chronic condition that occurs when your blood sugar is regularly too
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  high, is the most common type of diabetes, according to the National Institute of Diabetes
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  and Digestive and Kidney Diseases.
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  If not managed, type 2 diabetes can lead to problems including heart disease, stroke, and
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  kidney disease.
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  There are more questions about meat that need to be asked, such as the risk from poultry and
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  the possible effects of different cooking methods, said Dr.
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  Hilda Mulrooney, reader in nutrition and health at London Metropolitan University, in a news
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  release.
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  She was not involved in the study.
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  But the new research does line up with current nutritional guidelines that recommend lowering
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  meat consumption, Mulrooney said.
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  The study was observational, so the researchers could not conclude that the consumption of meat
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  was the direct cause of the diabetes, Mulrooney said.
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  But the connection was strong, said Forouhi, noting 'these findings were consistent across
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  populations in different world regions and countries.' Researchers analyzed data from
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  nearly 2 million people across 20 countries.
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  The team also accounted for factors including 'diet quality, physical activity, smoking,
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  alcohol intake, energy intake and body mass index that could impact the results and that
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  may otherwise exaggerate or mask the relationship of meat and type 2 diabetes,'
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  Forouhi added.
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  However, the data did not allow researchers to account for other things that may contribute to
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  type 2 diabetes, including family history, insulin resistance, and waist circumference,
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  according to Dr.
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  Duane Mellor, dietitian and spokesperson for British Dietetic Association and honorary
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  academic fellow at Aston University in the United Kingdom.
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  He was not involved in the research.
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  Those factors are more strongly associated with risk of developing diabetes than the factors
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  the researchers were able to account for, he added in a news release.
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  'It is possible that the increased risk associated with processed and red meat intake
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  could be a result of these other confounding factors,' Mellor said.
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  Even with those limitations, the evidence in the new study and current dietary
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  recommendations do make a strong case for cutting back on meat, Mulrooney said.
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  'Meat consumption generally exceeds dietary guidance,' she said.
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  'Current dietary guidance also recommends replacing red and processed meats with meats
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  such as poultry, in addition to reducing overall meat consumption using alternatives
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  such as peas, beans, lentils and tofu.'
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  Although there is not clear research yet into whether poultry consumption and type 2 diabetes
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  risk are connected, the recent study showed that replacing red meat and processed meats
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  with poultry did result in a lowered risk of developing type 2 diabetes, Mulrooney added.
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  'It is well known that generally the available processed meat such as ham, sausages, bacon,
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  hot dogs, salami or pepperoni are highly processed, containing chemical additives as
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  well as being high in salt, making them unhealthy for a wide range of health
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  conditions,' Forouhi said.
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  There are many ways to cut down, including, 'eating these meats less often, having smaller
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  portions, or swapping them for alternative foods rich in proteins,' she added.
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  And in addition to striving for a diet high in vegetables, fruits, nuts and beans, people
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  concerned about diabetes should make sure to incorporate regular exercise, Mellor said.
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  Let's turn our attention to a significant development in the treatment of severe allergic
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  reactions: the introduction of nasal spray epinephrine.
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  This new formulation, now available under the brand name Neffy, is being hailed as a
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  potential game-changer for those who suffer from severe allergies and are hesitant to use
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  traditional epinephrine autoinjectors like the EpiPen.
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  Nasal spray epinephrine utilizes a device that has already been involved in seven other FDA
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  approvals for emergency situations, including drug overdoses and frequent seizures.
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  This device combines epinephrine with an absorption enhancer known as dodecyl maltoside,
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  or Intravail, to ensure rapid absorption.
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  According to Dr.
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  Christopher Warren from the Center for Food Allergy and Asthma Research at Northwestern
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  University Feinberg School of Medicine, the nasal spray may be particularly useful in
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  equivocal cases of anaphylaxis.
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  He explains that the hesitation to use a needle-based autoinjector often leads people to
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  delay treatment, which can be dangerous.
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  'Stabbing your child in the leg with an autoinjector, or injecting yourself, is a big
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  move, and the fact that it's a needle is a deterrent for people,' Dr.
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  Warren told MedPage Today.
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  'They wait for the reaction to get worse, to figure out if they really need it.'
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  Dr.
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  Scott Sicherer, director of the Jaffe Food Allergy Institute at the Icahn School of
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  Medicine at Mount Sinai, echoed these sentiments.
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  He said that while the allergy community emphasizes the mantra of 'Epi First, Epi Fast,'
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  many patients still hesitate to use their epinephrine autoinjectors.
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  'They end up hesitating, or they end up going to the emergency room without having used the
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  epinephrine, even though it's a very safe and effective medication that makes them feel
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  better and has the potential to save lives,' Dr.
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  Sicherer noted.
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  But how will patients incorporate this new device into their treatment regimens,
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  especially when they already have options like the EpiPen and Auvi-Q?
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  Experts are still uncertain.
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  One concern raised by an FDA advisory committee was that nasal spray epinephrine has not been
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  studied directly in anaphylaxis, the condition it aims to treat.
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  While this is true for all epinephrine devices due to ethical and logistical challenges, the
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  committee recommended additional studies comparing repeat doses of the nasal spray with
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  intramuscular injections.
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  ARS Pharma, the developer of nasal spray epinephrine, completed these additional
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  studies, and the results were promising.
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  The nasal spray actually outperformed intramuscular injection in terms of blood
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  levels and clinical parameters like heart rate and systolic blood pressure in patients with
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  seasonal allergic rhinitis.
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  In another study, blood concentrations of epinephrine at 10 minutes were highest for the
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  EpiPen but comparable for the nasal spray and intramuscular injection.
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  By 20 minutes, the nasal spray and EpiPen were equivalent, while the intramuscular injection
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  remained slightly lower.
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  Dr.
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  Joel Brooks, a pediatric allergist at Columbia University Irving Medical Center, highlighted
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  that while blood concentrations were different, the important clinical outcomes were
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  comparable.
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  'Does that 10-minute mark really make a clinically significant difference if the levels
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  are lower?' he asked.
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  'The answer is probably not, especially when we look at other markers like heart rate and blood
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  pressure.
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  We look for the clinical improvement.'
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  Despite the promising results, some FDA advisors remain cautious.
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  Dr.
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  Lewis Nelson from Rutgers New Jersey Medical School pointed out that the nasal spray was not
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  tested in patients experiencing a severe allergic reaction.
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  'They really didn’t test it in the population in which it's going to be used, so it was
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  getting by largely on surrogate data,' he said.
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  'When you're giving it to someone without an allergic reaction, is the absorption in the
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  nose going to be the same?'
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  Dr.
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  Brooks suspects there will be three approaches to adopting nasal spray epinephrine.
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  One group will stick to their current devices, another will switch entirely to the new
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  product, and a middle group will carry both the autoinjector and the nasal spray.
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  Dr.
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  Warren hopes that postmarketing surveillance will eventually provide reassuring data on the
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  efficacy and safety of the nasal spray, allowing patients to rely on just one type of
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  device.
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  There are also practical advantages to the nasal spray.
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  It tolerates higher temperatures, up to 122°F, and has a longer shelf life of 30 months
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  compared to the EpiPen, which usually requires an annual prescription renewal.
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  Additionally, the price may be more affordable, capped at $199 for those who are uninsured or
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  have high-deductible health plans, with a copay of $25 for those with insurance.
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  Currently, the nasal spray is approved for use in children and adults weighing at least 66
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  pounds, but studies are underway to extend its use to pediatric patients who weigh less.
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  This could potentially make the nasal spray available to a broader population as early as
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  next year.
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  In summary, the introduction of nasal spray epinephrine offers a promising alternative for
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  those hesitant to use traditional autoinjectors.
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  While more research is needed to fully understand its efficacy in real-world settings,
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  the initial data are encouraging.
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  As always, patients should consult their healthcare providers to determine the best
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  treatment option for their specific needs.
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  That wraps up today's episode of Morning Medical with Dr.
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  Chow.
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  I hope you found the information enlightening and helpful.
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  Join me again tomorrow for more updates on the latest in medical and health news.
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  Have a great day!