New Weight Loss MedicationsPosted: Oct 12 in Medical Weight Loss News, Weight Loss Medication by Dr. Lazarus
Three medications* were approved for chronic weight management between 2012 and 2014 and we have had great success helping our patients not only lose weight, but keep it off long-term. We are excited not only that we have these safe, effective treatments, but also that there are several new medications in development that should become available in the not so distant future.
In the good old days, we called weight loss medications appetite suppressants. The idea was that you could take these medications while trying to lose weight to help be less hungry. The preferred term these days is “Anti-obesity medications.” This change in nomenclature is intended to illustrate that obesity is a chronic medical disease and is not going to be “cured” by a short-lived diet. We now understand that medications can only work so long as they are continued – a short term use of an “appetite suppressant” will not provide added benefit for long-term weight control. As such, we now think of using weight loss medications, or anti-obesity medications chronically, similar to how we would treat high blood pressure, diabetes or high cholesterol. For this reason, it is important for medications to show that they are not only effective in helping a person lose weight, but also effective – and safe – to help a person keep the weight off over the long-haul.
Contrave is a combination of bupropion (also marketed as an anti-depressant and a stop-smoking treatment) and naltrexone (also marketed for alcohol addiction and to block the effects of opioid pain medications). It works in two areas of the brain to decrease hunger and decrease cravings. It is taken twice a day to help provide 24 hour appetite and craving control. It has demonstrated that it can provide safe weight loss and help sustain that weight loss.
Qsymia is a combination of phentermine (a weight loss medication we’ve been successfully using to help people lose weight since 1959) and topiramate (also approved to reduce seizures and reduce migraines). The phentermine component helps control appetite through the day while the topiramate component helps control appetite through the evening. It is taken as 1 pill in the morning. It is also approved for chronic weight management.
Our newest anti-obesity medication is Saxenda. The molecure in Saxenda, liraglutide, is also marketed as Victoza (for the treatment of type II diabetes). It is a synthetic analogue of a hormone made in the small intestine called GLP-1 (glucagon-like-peptide 1). This hormone is released after eating and signals the stomach to slow down pumping and the brain to slow down eating, providing a sense of satisfaction after the meal. Victoza has a proven track record having helped millions of people with diabetes since 2010. It has also been studied in patients with heart disease, and has been shown to reduce the risk of an adverse cardiovascular event. Saxenda is a once a day injection, and has data showing improvement in sustained weight loss at 3 years.
On the horizon…
What does the future hold with regards to weight loss medications? There are many medications in development, including:
- Once-weekly GLP-1: Similar to the diabetes world where we have been transitioning from once a day injections of GLP-1 analogues to once-a-week injections, research is underway to bring a once weekly injection to the marketplace. The weekly GLP-1’s have proven to be very safe and effective in diabetes treatment, and some even provide very good risk reduction for adverse cardiovascular events like heart attacks. We are excited to watch the research on these agents for weight loss, and are hopeful we will see one on the market with improved weight loss (hopefully > 10%) and safety by 2021.
- GLP-1 combination treatments: Companies are researching adding a second hormone to the GLP-1. Hormones under consideration include GIP (gastric inhibitory peptide), amylin (a pancreatic hormone) and leptin (a hormone made in the fat cells) among others. The hope would be that the hormones would provide an additive weight loss effect, improving the amount of weight loss that can be achieved and sustained.
- Other combination treatments: In addition to the above hormones, we continue to utilize different medication combinations to enhance weight loss, and are hopeful that we will see research studies justifying the safe and effective use of combination pharmacotherapy. In other disease states like high blood pressure or diabetes, if goals are not achieved with a single treatment, often a second treatment is added. We are hoping to see similar research in obesity.
- Combination surgery / medication: In addition to improving pharmacotherapy, recent studies show that adding medication to bariatric surgery (phentermine / topiramate) improved the ability to lose and sustain weight loss.
Stay tuned! As the field develops, we promise to keep you up to date!
*Note that a 4th medication was also approved – Belviq (Lorcaserin). However, this medication was voluntarilly withdrawn from the market in 2020.