Weight loss achieved through injectable GLP-1 drugs could be maintained by new oral pills entering the market and become a preventable treatment for chronic health conditions.
Research presented at the European Congress on Obesity (ECO) in Istanbul showed the effectiveness of daily oral orforglipron, known as Foundayo, and developed by US company Eli Lilly.
The drug has recently been approved for use in the UAE, with Novo Nordisk’s oral version of its semaglutide drug, Wegovy, awaiting regulatory approval to be used in the Emirates.
Foundayo went into circulation in April in Dubai and was approved for use in Abu Dhabi this month, with prices starting from Dh773 for 0.8mg, rising to Dh1,599 for the strongest 17.2mg dose.
While the efficacy of injectable therapies has been repeatedly proven in clinical trials, how best to maintain weight loss achieved with GLP-1 therapies like Mounjaro and Wegovy remains a key area of research.
Speaking at the ECO in Turkey, Dr Louis Aronne, director of the comprehensive weight control centre at Weill Cornell Medicine, New York, said patients on injectable drugs maintained their weight loss, despite switching to oral medication.
“So far, injectable obesity medications have proven to be highly efficacious and safe for use, but persistence on therapy remains challenging,” Dr Aronne said.
“This trial provides evidence of how to switch to oral therapy and its ability to improve weight loss maintenance compared with stopping therapy.
“It could serve as a potential solution for persistence on therapy for those who wish to stop injectable therapy owing to patient preference, convenience, cost or cold storage requirements.”
Safe to stop?
A common misconception among people living with obesity, and some clinicians, is that obesity medications can be discontinued once a weight target has been reached.
However, stopping medication after intentional weight loss can lead to excess weight returning and loss of improvements in cardiometabolic health, Dr Aronne said.
Dr Aronne said oral pills could be used more widely as a preventive measure in the future.
“The average patient we see in our centre, and in every obesity centre, is that the average BMI is 33 – that person is already on seven medications and has sleep apnoea,” he said.
“What would happen if you started treating people when they had a BMI of 25 or 27 and they never got to that point?
“We are asking now if the prevention model could work where as soon as you go over the line, you start treatment with a medicine like orfarglipron, oral semaglutide or others in development. Then you never get to the point of severe obesity.
“That is a very appealing model, but it has to be proven. By having a daily pill, like for hypertension, it is a treatment for life.”
While that has obvious cost implications, preventing the onset of chronic disease that often requires expensive, lifelong treatments could become more economically effective.
The Emirates Drug Establishment is due to make a regulatory decision on a Wegovy weight loss pill.
The drug has already proved popular in the US after FDA approval.
“In the first few weeks of the launch of the Wegovy pill in the US, there were close to two million prescriptions and one million patients using the pill,” said Venkat Kalyan, Novo Nordisk general manager for the Gulf region.
“What we have seen is many of these patients are also new to the treatment, so they're not shifting from the injections. That means many new patients are using obesity treatments in a pill.”
Menopause
Other research displayed at the ECO in Turkey showed GLP-1 drugs were having wider health benefits, outside of obesity related disease.
Novo Nordisk’s Step-Up trial, based on clinical weight management, showed obese women taking semaglutide during menopause not only lost weight, they reduced their waist size and had less visceral fat, cutting the risk of heart attack and stroke.
Injected semaglutide showed an average 22.6 per cent weight loss for premenopausal women with obesity, with more than four in 10 achieving 25 per cent or more weight loss.
They were also found to have less depression and other menopause symptoms. Weight gain is common during menopause.
It affects more than half of women, largely due to hormone changes and a shift in oestrogen levels that disrupts metabolism, leading to fat storage.
On average, women entering menopause add 1.5kg of weight, with the perimenopause stage the most accelerated period of gains.
Reduced lean muscle mass, added to the natural transition to store tummy fat when oestrogen levels drop, and disrupted sleep patterns also contribute to weight gain.
Another plus was semaglutide's positive affect on migraines, usually brought on by hormone changes, such as the brain’s naturally occurring feel-good chemical serotonin.
Trial data from 32,000 women in the US showed women taking the drug long term had an average 42–45 per cent lower risk of migraine, six months after starting the drug.
They also reported a 25 per cent lower risk of depression, compared with menopausal hormone therapy alone.
“Menopause, associated weight gain and unwanted changes in cardiometabolic markers can significantly impact long-term health and well-being of women,” said Dr Emilia Huvinen, a gynaecologist researcher and associate professor at the University of Helsinki.
“Still, they remain one of the most neglected areas in obesity research.
“Whether we look at cardiovascular outcomes or weight loss across menopausal stages, semaglutide appears to offer meaningful benefits for women with obesity that extend well beyond weight loss alone.”
