Weight loss plus reduced cravings
In another presentation, Sean Wharton, MD, PharmD, said, “In adults with overweight or obesity, substantial weight loss with semaglutide 2.4 mg was accompanied by short- and long-term improvements in control of eating.”
Dr. Sean Wharton
“Most patients living with obesity who are attempting to decrease calories will have food cravings, based on the biological parameters of weight preservation,” Dr. Wharton, medical director at the Wharton Medical Clinic, in Hamilton, Ont., explained in an email.
The degree of craving varies from patient to patient, likely based on genetics, he added. Research in this field is still emerging.
“I believe that semaglutide 2.4 mg is a game-changer in the field of weight management, and it will change the dialogue for insurance plans and with policymakers regarding coverage for this medication,” said Dr. Wharton.
“The data from the STEP programs are very strong. I am certainly hoping for a change to bias against covering these medications that we have seen in the past,” he said.
Clinically meaningful weight loss
When presenting the STEP 8 findings, Domenica M. Rubino, MD, said: “Participants were significantly more likely to achieve clinically meaningful weight loss thresholds with semaglutide 2.4 mg versus liraglutide 3.0 mg, accompanied by greater improvements in cardiometabolic risk factors.”
For example, patients can have better mobility, which is important for quality of life, Dr. Rubino, director of the Washington Center for Weight Management and Research, Arlington, Virginia, noted.
A smaller percentage of patients respond to liraglutide, she added. Clinicians need to individualize treatment.
When asked, “How do you choose which medical therapy?” Dr. Rubino responded: “We sit and talk.” Finding the medical therapy that fits the patient depends on things such as the patient’s insurance coverage and ability to tolerate side effects such as dehydration, diarrhea, and nausea.
When asked, “How do you switch from liraglutide to semaglutide?” she noted that there are no current guidelines for this. “You have to be careful. Start on the lowest dose of Wegovy. Be cautious, conservative.”
Still early days, caveats remain
“The STEP trials as a group appear to be making the case that obesity may now be considered a medically manageable disease, based on the experience with semaglutide,” Julie R. Ingelfinger, MD, who was not involved with the research, commented in an email.
Dr. Julie R. Ingelfinger
“STEP 5 and 8 may suggest that weight loss occurs and is sustainable in overweight persons without diabetes with one or more comorbidities or in obese persons without diabetes,” added Dr. Ingelfinger, professor of pediatrics, Harvard Medical School, consultant in pediatric nephrology, Massachusetts General Hospital, Boston, and deputy editor, The New England Journal of Medicine.
However, “even 2 years, in the case of STEP 5, and ~68 weeks in the case of STEP 8, may not be long enough to know whether semaglutide is as promising as these brief summaries (abstracts) suggest,” she cautioned.
“Obesity is a chronic condition, and very long-term therapy and management are required,” Dr. Ingelfinger continued.
“Further, it is hard to generalize when gastrointestinal adverse events are common in a study,” she said. For example, in STEP 8, they were just as common with semaglutide as with the comparator liraglutide, she noted.
“The racial and ethnic representativeness of these studies does not reflect population distributions in the U.S., limiting generalization,” she continued.
“So, there remain caveats in interpreting these data.”