Russell Scott MB ChB BMedSci FRACP PhD (Monash)
Clinical Professor of Medicine, Christchurch, NZ
Clinical Investigator, NZ Clinical Research OpCo, Christchurch division.
Obesity is prevalent in NZ and Australia. With ageing, there is an increase in fat mass and decrease in lean muscle mass and is an issue with menopause. Lifestyle and diet changes are typically used with disappointing outcomes. Traditional pharmacotherapeutic agents seldom achieve useful weight reduction beyond 1 year. The glucagon-like peptide-1 (GLP-1) analogue Exenatide was first used around 1995 (mainly in T2DM) and a long-acting version also was developed. Dose-dependent gastrointestinal side effects limited their use. Newer agents such as Liraglutide, dulaglutide and semaglutide (the latter not in NZ) are funded for type 2 DM and can deliver reasonable metabolic results while titrating for side effects. The attraction for use in type 2 DM, is cardio renal benefit. Guidelines rank them as the next medication option after metformin in those with obesity/insulin resistance. They are being used increasingly in other metabolic situations such as sleep apnoea, insulin resistance, menopause, NASH.
Other gut, pancreatic and brain peptides such as glucagon, oxyntomodulin, peptide YY (PYY), and glucose-dependent insulinotropic peptide (GIP) are emerging key targets for medications to improve metabolics and reduce obesity. Novel dual agonists for GLP-1/glucagon and GLP-1/GIP have been / and are being developed. Tirzepatide is registered in Australia, not available in NZ. Triagonists (GLP-1/GIP/glucagon) show initial favourable clinical trial results. However, the track record of weight regulators uncomfortable with market withdrawal being a repeated feature over the last 30 years; the most recent being lorcaserin (cancer risk). The claims for the ‘latest and greatest’ dominate 2023 medical news with pharma giants competing for position.
The talk will focus on the role of newer medications that improve metabolic issues associated with high body weight. It will also profile those emerging.