I am a bit surprised that semaglutide is still fairly popular. Given it is not cheaper, is both less effective at weight loss and has more side effects than tirzepatide, it is really hard to think of a good reason for starting anyone on it in preference to tirz. It has more accumulated evidence for benefits outside of weight loss - for cardiovascular and kidney risks etc, but all the research on tirz so far strongly suggests it is a class effect and is very likely to be the same. Obviously if someone is already on it and it is working for obesity or diabetes switching makes little sense, but retaining old patients is not going to help their share price much.
Unfortunately for novo, lily just picked better drugs to develop or was luckier. Cagri was pretty disappointing for weight loss on its own, and combined with sema is nearly as good as tirz but with more side effects, and both oral ozempic and orfoglipron are also less effective and have more side effects than tirz. Cagri looks good as an add on to reta or tirz at low doses but given the different ownership , not likely to even get studies. Oral ozempic never got promoted much and was not released everywhere, it definitely is not available in Aus, maybe due to initial production limitations so they focused on the injectable version? Orfoglipron could end up popular if people want to avoid injections, I wonder if ozempic being around for so long and being talked about so much has reduced peoples' aversion to injectable drugs a bit?
Unless novo can get their triple agonist out before reta which seems very unlikely then it is just going to get worse for them once reta is available, putting sema at the third ranked choice at best. In the longer term sema is going to end up as the cheaper less preferable option to stay in the market at all, especially once more and more drugs start being approved. In the grey market I cannot think of any reason to use sema, except maybe as a low dose add on to higher doses of reta or tirz.
Novo weight-loss drug may preserve lean body mass better than Lilly's, study finds
By Nancy Lapid Reuters - 17 minutes ago
* GLP-1 drugs yielding greater weight loss have worse effects on lean body mass
* Patients on tirzepatide lost more muscle and other non-fat tissues than patients on semaglutide
* Exercise during treatment is essential with both drugs, researchers say
April 16 (Reuters) - Eli Lilly's ( LLY ) GLP-1 drugtirzepatide yields greater weight loss on average than NovoNordisk's semaglutide, but at a greater expense tomuscles and connective tissues, according to a study publishedthis week ahead of peer review.
Tirzepatide, sold as Zepbound and Mounjaro, and semaglutide,under the brand names Wegovy and Ozempic, have become wildlypopular for weight loss and have demonstrated other healthbenefits, such as heart-protective properties. But there has been concern that they induce loss of muscle and other components of lean body mass along with fat.
The researchers analyzed data on roughly 1,800 patients using tirzepatide and 6,200 using semaglutide.
Tirzepatide was consistently associated with greater loss of lean body mass than semaglutide. Tirzepatide patients lost an average of 1.1% more lean body mass after three months and 2%after 12 months of continuous use, the analysis by Massachusetts-based data analytics firm, nference, found.
"This suggests that patients shouldn't simplistically be thinking, 'I want to lose X amount of weight and I'll go with the option that delivers greater weight loss,'" said study leader Venky Soundararajan of nference on the study data published online.
Patients were tracked before and during treatment either with low-radiation scans or with "smart" scales that estimate body fat percentage, muscle mass, bone mass, and other components.
The study cannot explain why lean body mass loss was greater with tirzepatide, which mimics the hormones GLP-1 and GIP, compared with semaglutide, which only mimics GLP-1. Mimicking the hormones slows digestion and makes patients feel full.
A Novo spokesperson did not comment on the current study, but said changes in muscle mass did not significantly differ between semaglutide and placebo groups in clinical trials, and physical function was preserved.
A Lilly spokesperson said fat loss achieved with healthy dieting is similarly accompanied by lean body mass loss.
In its late-stage clinical trial, "the ratio of fat-mass loss to lean-mass loss for patients treated with tirzepatide was generally consistent with that reported in lifestyle-based treatments for obesity," the spokesperson said.
STUDY DETAILS
Roughly 10% of tirzepatide users who lost more than 20% oftheir total body weight were found to have lost more than 5% of their lean body mass. That was true for fewer than 7% of semaglutide users who lost the same percentage of body weight.
Decreased exercise tolerance during treatment was linked with greater lean body mass loss in both groups, but to a greater extent in tirzepatide-treated patients.
Higher doses, longer treatment, and the presence of musculoskeletal pain before treatment began were also associatedwith greater lean body mass decline with both drugs, theresearchers found.
"It's a vicious cycle," Soundararajan said. "If you start with a drug which puts you at a greater probability of lean body mass loss... and you have a preexisting history of musculoskeletal diseases, it puts you at greater risk of lower tolerance to exercise. And if you're not exercising when you're on these medicines, you are essentially causing attrition of lean body mass."
nference funding comes from health systems, institutional investors, and venture capital firms.(Reporting by Nancy Lapid; Editing by Michele Gershberg and Bill Berkrot)
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