‘Increasingly better weight-reducing medication’

Within 2 years, the treatment landscape for weight-reducing medications will look completely different. This is what Prof. Liesbeth van Rossum, internist-endocrinologist at Erasmus Medical Center in Rotterdam, expects. During the National Nutrition Congress on March 14 in Veenendaal, she showed which new products are coming. ‘The results are getting closer to those of bariatric surgery.’

No miracle cures

A healthy lifestyle is the basis of the treatment of obesity, Van Rossum emphasized during her presentation. With a combined lifestyle intervention, weight loss after one year is on average 3.5 percent. Only if lifestyle has insufficient effect can weight-reducing medication be considered. These are not miracle cures, but aids that will probably have to be used for life.

Mysimba and Saxenda

Van Rossum showed a nice overview of the different generations of weight-reducing medication. The 1^e generation consisted of orlistat (Xenical/Alli), which was associated with side effects such as greasy stools. Currently the 2^e generation of weight-reducing medication – liraglutide (Saxenda) and naltrexone/bupropion (Mysimba) – reimbursed in basic insurance. Van Rossum said that this medication is effective in the majority of people with obesity. For example, more than half have at least 5 percent weight loss after 1 year and approximately 1 in 3 even has 10 percent weight loss after 1 year.

Third generation on the way

Soon the 3^e generation of medication expected in this group. According to Van Rossum, this is even more effective, with an average of 15-18 percent weight loss. The first drug from this generation is semaglutide (Wegovy), the reimbursement of which is currently being assessed by the Healthcare Institute. With semaglutide, 86 percent achieve a weight loss of at least 5 percent after 1 year. 69 percent experienced a 10 percent weight loss and 32 percent even a 20 percent loss.

Cocktail remedies

Van Rossum also expects more and more “cocktail products” in the future; combinations of multiple medications, such as tirzepatide (duo-agonist) and retatrutide (tri-agonist), which may be even more effective. Van Rossum: ‘This can achieve an average weight loss of 20-30 percent. The results are therefore coming closer to those of bariatric surgery, which achieves between 12 and 45 percent weight loss.’ She said that weight-reducing medication provides more health benefits than just weight loss. There are also cardiometabolic improvements, such as less hypertension, dyslipidemia and inflammation and less (risk of) type 2 diabetes, cardiovascular disease and depression.

From GLI to surgery

According to Van Rossum, the average weight loss with different treatments is:

• Combined lifestyle intervention (GLI): 3.5 percent
• 1^e and 2^e generation weight-reducing medication: 5-10 percent
• 3^e generation of weight-reducing medications: 15-18 percent
• “Cocktail agents” (duo- and tri-agonists): 20-30 percent
• Bariatric surgery: 12-45 percent

Overview of 3 generations of weight-reducing medication

1^e generation

Orlistat (Xenical/Alli)

• One capsule 3 times a day
• In 44 percent, at least 5 percent weight loss after 1 year
• At 20 percent, at least 10 percent weight loss after 1 year
• Most common side effects: more frequent and greasy, oily or liquid stools, strong urge to defecate, fecal incontinence, passing wind, abdominal pain, headache, upper respiratory tract infections
• Costs 73 euros per month (not reimbursed)

2^e generation

Naltrexone/bupropion (Mysimba)

• One tablet twice a day
• At 55 percent, at least 5 percent weight loss after 1 year
• At 30 percent, at least 10 percent weight loss after 1 year
• Most common side effects: nausea, constipation, vomiting, headache
• Costs €98 per month (reimbursed by basic insurance from August 2022)

Liraglutide (Saxenda)

• An injection daily
• In 63 percent, at least 5 percent weight loss after 1 year
• In 34 percent, at least 10 percent weight loss after 1 year
• Most common side effects: nausea, constipation, vomiting, headache, diarrhea
• Costs €250 per month (reimbursed by basic insurance from April 2022)

3^e generation

Semaglutide (Wegovy)

• An injection every week
• In 86 percent, at least 5 percent weight loss after 1 year
• In 69 percent, at least 10 percent weight loss after 1 year
• In 32 percent, at least 20 percent weight loss after 1 year
• Most common side effects: nausea, constipation, vomiting, headache, diarrhea, abdominal pain, fatigue
• Costs approximately €250 per month (reimbursement is still being assessed by the Healthcare Institute)