More needles? A daily pill can work as well as Wegovy injections to treat obesity

What if treating obesity could be as simple as taking an effective pill?

It’s a notion that has long fueled the hopes of many of the over 40% of Americans considered obese — and fueled criticism from those who advocate greater weight acceptance. Soon this may be a reality.

High-dose oral versions of the drug in weight loss drug Wegovy may work just as well as popular injections when it comes to shedding pounds and improving health, according to final results from two studies released Sunday evening. The potent tablets also seem to work for people with diabetes, who notoriously struggle with weight loss.

Drugmaker Novo Nordisk plans to apply to the US Food and Drug Administration for approval of the pills later this year.

“If you ask people a random question, ‘Would you rather take a pill or an injection?’ People overwhelmingly prefer a pill,” said Dr. Daniel Bessesen, chief of endocrinology at Denver Health, which treats obese patients but was not involved in the new research.

This assumes, Bessesen said, that both ways of taking the drugs are equally effective, available and affordable. “Those are the most important factors for people,” he said.

There are other diet pills on the market, but none achieve the substantial reductions seen with injected drugs like Wegovy. Obese people will be “thrilled” to have such an effective oral option, said Dr. Katherine Saunders, clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight loss center.

Novo Nordisk already sells Rybelsus, which is approved to treat diabetes and is an oral version of semaglutide, the same drug used in the diabetes drugs Ozempic and Wegovy. It comes in doses of up to 14 milligrams.

But results from two landmark trials published at the American Diabetes Association’s annual meeting looked at how doses of oral semaglutide as high as 25 milligrams and 50 milligrams worked to reduce weight and improve blood sugar and other health markers.

A 16-month study of approximately 1,600 people who were overweight or obese and already treated for type 2 diabetes found that daily high-dose pills lowered blood sugar significantly better than the standard dose of Rybelsus. Starting from a base weight of 212 pounds, the higher doses also caused weight loss of between 15 and 20 pounds, compared to around 10 pounds with the lower dose.

Another 16-month study of more than 660 obese or overweight adults with at least one related condition — but not diabetes — found that the 50-milligram daily pill helped people lose an average of about 15% of their weight. body weight, about 35 pounds, compared to about 6 pounds with a dummy pill or placebo.

This is “notably consistent” with weight loss stimulated by weekly injections of the highest dose of Wegovy, the study authors said.

But there were side effects. About 80% of participants taking any dose of semaglutide by mouth experienced problems such as mild to moderate bowel problems such as nausea, constipation, and diarrhea.

In the 50 milligram obesity trial, there was evidence of higher rates of benign tumors in people taking the drug compared to a placebo. Additionally, about 13% of those who took the drug had “altered skin sensation,” such as tingling or extra sensitivity.

Medical experts predict the pills will be popular, especially among people who want to lose weight but are afraid of needles. Moreover, tablets are said to be more portable than injection pens and they do not need to be stored in the refrigerator.

But the pills aren’t necessarily a better option for the hundreds of thousands of people already taking injectable versions such as Ozempic or Wegovy, said Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital.

“I don’t find any significant hesitation surrounding receiving an injection,” she said. “A lot of people like the ease of taking medication once a week.”

Also, she says, some patients may actually prefer the injections to the newer pills, which must be taken 30 minutes before eating or drinking in the morning.

Paul Morer, 56, who works for a hospital system in New Jersey, lost 85 pounds using Wegovy and hopes to lose 30 more. He said he would probably stick to weekly injections, even if pills were available.

“I do it on Saturday morning. It’s part of my routine,” he said. “I don’t even feel the needle. This is not a problem.”

Some critics also worry a pill could put pressure on obese people to use it, fueling social stigma against people who can’t or won’t lose weight, said Tigress Osborn, president of the National Association to Advance Grease Acceptance.

“There’s no escaping the narrative that your body is bad and should change,” Osborn said.

Yet Novo Nordisk is banking on the popularity of a higher-dose pill to treat both diabetes and obesity. Rybelsus sales hit around $1.63 billion last year, more than double the 2021 figure.

Other companies are working on oral versions of drugs that work as well as Eli Lilly and Co.’s Mounjaro – an injectable diabetes drug that should soon be approved for weight loss. Lilly researchers have reported promising mid-stage trial results for an oral pill called orforglipron to treat obese or overweight patients with and without diabetes.

Pfizer also released midline results for dangulgipron, an oral diabetes medication taken twice daily with food.

Novo Nordisk officials said it was too early to say how much the company’s high-dose oral pills will cost or how the company plans to secure adequate manufacturing capacity to meet demand. Despite the growing popularity, injectable doses of Wegovy will be in short supply until at least September, company officials said.

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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Science and Education Media Group. The AP is solely responsible for all content.

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