2023-11-21 08:30:18
In France, nearly one in two French people are affected by overweight and obesity. Epidemiological data reveal a very clear increase in impacted children and adults. Faced with this scourge, new therapeutic solutions are being developed. In the USA, the American Medicines Agency (FDA, Food and Drug Administration) has just authorized a new drug to fight this metabolic disease. Explanations.
Obesity, a multifactorial metabolic disease
Face to overweight and obesity, medicinal solutions are rare. Support is mainly focused on hygienic and dietary measures (diet, physical activity, etc.) and in severe forms on the obesity surgery or bariatric surgery, which has experienced significant growth in recent years in France. Medicines against obesity are rare and in the past some of them have been the subject of several health scandals.
Each new drug indicated in the management of obesity therefore arouses keen interest but also calls for vigilance. In recent years, a new class of drugs intended to fight type 2 diabetes has been developed, GLP-1 analogues (Glucagon Like Protein-1). During clinical trials carried out on these new molecules, researchers found that they were capable, not only of improving glycemic balance, but also of contributing to a better body weight control.
GLP-1 analogues in diabetes and obesity
These observations have led to questions about the benefit of prescribing these medications, firstly in overweight or obese diabetic subjects, then in obese subjects, whether they are diabetic or not. Currently, in France, only one GLP-1 analogue drug is available for the treatment of certain forms of severe obesity, liraglutide. After initiation of treatment, weight loss is assessed at 12 weeks. If it is not greater than 5% of the patients’ weight, the treatment is stopped.
In the USA, a new GLP-1 analogue has just been authorized for the treatment of obesity, tirzepatide. Pharmacologically, this new drug has a dual mechanism of action, because it is both GLP-1 analogue and GIP analogue (glucose-dependent insulinotropic polypeptide). GIP and GLP-1 are receptors for a hormone, incretin, which acts on insulin secretion, but also on gastric emptying and therefore on appetite and weight gain. The authorization issued by the American drug agency indicates that tirzepatide may be prescribed in adult subjects who are overweight or obese, with at least one comorbidity: arterial hypertension, lipid disorders, type 2 diabetes, obstructive sleep apnea.
Medications under surveillance
In Europe, tirzepatide is only available for the indication of type 2 diabetes and cannot be prescribed for the treatment of obesity. In France, this medicine is not currently available. The authorization of this drug in the USA followed the publication of two clinical trials. In one of these trials, carried out on 2,539 overweight or obese adults, tirzepatide made it possible to obtain an average weight loss of between 15 and 21 kg, depending on the dose administered. By the end of 2023, tirzepatide should be available in the USA in 6 different dosages. A marketing authorization application has also been filed with the European Medicines Agency.
These new drugs against obesity, with promising results, must be prescribed in specific contexts, by doctors specializing in the management of obesity. Indeed, these treatments present contraindications, but also sometimes significant side effects. The use of these treatments is generally reserved for severe forms of obesity with associated comorbidities. They fit into comprehensive management of obesityin order to enable significant and lasting weight loss, without compromising the health of patients.
Estelle B., Doctor of Pharmacy
Sources
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