Weight-loss jabs and pills such as Wegovy and Mounjaro have the glamour of association with celebrity users, including Oprah Winfrey.
asserted
jabs → have → Winfrey
The public has embraced them too, with millions of people taking the medicines in the UK.
But amid the enthusiasm for those medications, known as GLP-1s, an older, cheaper anti-obesity drug that might be a better choice for some patients is being ‘overlooked’, a leading expert says.
uncertain
expert → embrace → patients
Mysimba, a pill containing naltrexone and bupropion, is licensed in the UK as a treatment for people with obesity, or who are overweight with weight-related health problems.
asserted
who → contain → problems
In trials, people using Mysimba lost around 8 per cent of their starting weight.
asserted
people → use → weight
That is lower than the amount lost by people using the latest GLP-1s.
asserted
That → lose → GLP-1s
In studies of Mounjaro, participants taking the highest doses lost around 22 per cent of their body weight.
asserted
participants → take → weight
However, not everyone needs to slim down to that extent, says Alexander Miras, a clinical professor of medicine at the University of Ulster who specialises in obesity and type 2 diabetes.
asserted
who → need → obesity
‘If someone’s health can improve with an 8 per cent weight loss, then those people can use the medication,’ he says.
asserted
he → improve → medication
In trials, people using weight-loss medication Mysimba lost around 8 per cent of their starting weight.
asserted
people → use → weight
That is lower than the amount lost by those using the latest GLP-1s
He suggests Mysimba might be best used by people with ‘mild obesity’, such as those whose BMI (body mass index) just tips them into that category, or who have mild weight-related complications such as high blood pressure.
uncertain
who → lose → pressure
‘The cost is reasonable – and it is one of the cheapest obesity drugs on the market,’ he adds.
asserted
he → add → market
At Superdrug online pharmacy, for example, a month of Mysimba costs £115, while a month of Mounjaro costs between £179 and £339.
asserted
month → cost → 179
GLP-1s mimic a natural hormone that is released after eating and tells the brain it is full.
asserted
it → mimic → brain
Naltrexone is a drug that treats alcohol and opioid addiction – it blocks the brain’s reward systems.
asserted
it → treat → systems
Bupropion is an anti-depressant that has also been used as a smoking cessation aid, and stimulates brain chemicals such as dopamine that reduce appetite.
asserted
that → use → appetite
Because they work in different ways, putting the two medications together means they can reduce appetite and cravings more effectively than alone.
asserted
they → work → appetite
Both GLP-1s and Mysimba target the hypothalamus, part of the brain which, among its other functions, controls energy intake, hunger and fullness (although they work through different receptors).
asserted
they → target → receptors
‘Mysimba also works in other parts of the brain involved with the pleasure of food – what we call the reward areas of the brain,’ says Professor Miras.
asserted
Miras → work → brain
The parts of the brain involved in the processing of reward from alcohol and drugs also process the reward value of food.
asserted
parts → involve → food
While GLP-1s also appear to have some effects in the brain’s reward networks, the evidence is ‘not as well developed as [for] Mysimba’, he says.
asserted
he → appear → Mysimba
It makes Mysimba ‘particularly good’ for people who have cravings, binge-eating disorders or who eat in response to emotions such as stress.
asserted
who → make → stress
‘It is the case that all the noise about the GLP-1 agonists has tended to drown out the availability of other pre-existing weight-loss treatments,’ says Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London.
asserted
Ward → tend → London
She says patients should be alert, however, to ‘fairly significant, albeit uncommon, side effects’ in the older drug, the most serious of which include suicidal thoughts.
asserted
serious → say → thoughts
GLP-1s mimic a natural hormone that is released after eating and tells the brain it is full
Other potential side effects include headaches, irritability and insomnia.
asserted
effects → mimic → headaches
The fact that GLP-1s are tolerated by more people is part of the explanation for them taking off where Mysimba did not, says Professor Miras.
asserted
Miras → tolerate → explanation
But a further factor is likely to be that the companies involved in Mysimba are much smaller, with smaller marketing budgets, than the pharma giants Novo Nordisk and Eli Lilly behind the blockbuster GLP-1s, he says.
asserted
he → involve → GLP-1s
The National Institute for Health and Care Excellence (Nice) ruled in 2017 that there was not enough evidence to prove Mysimba would be cost-effective for the NHS.
asserted
Mysimba → rule → NHS
At the time, it was compared only against lifestyle changes – rather than other available obesity drugs – and Nice has since increased its cost-effectiveness thresholds, raising the question of whether the same decision would be made today.
asserted
decision → compare → question
That Nice decision is another factor in its relative obscurity, says Professor Miras.
asserted
Miras → say → obscurity
The maker of Mysimba, Contrave, did not respond when the Daily Mail asked whether it hoped to seek fresh approval from Nice.
asserted
it → respond → Nice
Mysimba could potentially be used alongside GLP-1s, as well as instead of them, says Professor Miras – although the financial burden of paying for two medicines ‘might be too much’ for many patients.
uncertain
burden → use → patients
He is worried about tunnel vision in the field that focuses on GLP-1s at the expense of other innovations.
asserted
that → worry → innovations
‘There is more to life than GLP-1s,’ he says.
asserted
he → be → GLP-1s
They are going to be with us for decades to come and they are evolving.
asserted
they → go → decades
‘But we need to be a bit more creative.
asserted
we → need → ?
We need to be looking at other molecules, other targets that can be used in order to develop new medications.’
asserted
that → need → medications
There are a few in the pipeline, he says – but nothing likely to become available in the next few years.
asserted
he → be → years
‘GLP-1 medicines have transformed obesity treatment and the excitement around them is justified: they are highly effective, generally well tolerated, and can bring health benefits beyond weight loss.
asserted
they → transform → loss
But they are not the whole story,’ says Dr Bruno Halpern, president of the World Obesity Federation, a global charity which promotes research into and policies to target obesity.
asserted
which → say → obesity
‘Older medicines that work in different ways can still be valuable for people who don’t respond to GLP-1s, cannot tolerate them, cannot access them or simply need a different approach.
asserted
who → work → approach
…and 1 more, not listed.
The Aporia
