In football times like these, one could say that the team was completed with the “star” player: today in Argentina the injectable tirzepatide (Mounjaro), different from its predecessors, was officially presented has double effect by mimicking the job of two hormones that the body naturally produces. On the one hand, it activates the GIP receptors (glucose-dependent insulinotropic peptide); on the other hand, GLP-1 (glucagon-like peptide-1).
He GLP-1 It is a hormone that the body releases in the intestines reduces food intake because it increases satiety, slows gastric emptying and increases the secretion of insulin, the hormone secreted by the pancreas that regulates blood sugar levels. He GIPmeanwhile there is another hormone that acts as a modulator of adipose tissue metabolism and energy efficiency and, in combination with the action of GLP-1, contributes to greater weight loss.
To date, available medications have only had an agonistic effect (i.e Binding and activation) on GLP-1; Therefore, this new class of drugs promises stronger results in weight loss and improvement of other metabolic and cardiovascular indicators.
Mónica Katz, coordinator of the Obesity Group of the Argentine Nutrition Society (SAN), emphasized during the official presentation of the new injectable that “it produces a synergistic effect: during.” GLP-1 reduces appetite, improves satiety and promotes slower gastric emptying, GIP has a direct effect on the Fat tissue and leads to weight loss, predominantly at the expense of fat mass.”
Katz was one of the speakers at the meeting organized by the Adium laboratory, which promotes, markets and distributes tirzepatide in the country through an agreement with the Eli Lilly laboratory – which no longer carries out activities in Argentina since July 2021. Compared to already known products, it was shown that the novelty achieved a weight reduction of up to 26% within 72 weeks of treatment, compared to the injectable predecessor (semaglutide), which achieved up to 17%, both drugs at maximum dosage. These are results similar to those of bariatric surgery. but without having to undergo surgery, emphasized Mónica Katz.
This medication It can only be used with a doctor’s prescriptionas an adjunct to diet and exercise for the treatment of inadequately controlled type 2 diabetes (T2DM) and for chronic weight control in people who are obese (body mass index BMI ≥ 30) or overweight (BMI ≥ 27) and who also have an associated medical condition (e.g. high blood pressure, high cholesterol, heart disease, prediabetes or sleep apnea).
Tirzepatide It is administered as a solution for injectionfor subcutaneous use and weekly frequency, in doses ranging from 2.5 mg to 15 mg, for a graduated treatment regimen in which doses are increased according to the response of each patient. This product is available in multi-dose prefilled pen format (KwikPen). Like all injectables, it must be stored in a cool place, between 2°C and 8°C. In the Adium laboratory they made it clear for the time being: The 2.5 mg and 5 mg doses will be available in the country and from next year the largest will reach the maximum, which is 15 mg.
Like any drug, tirzepatide has side effects (nausea, vomiting, diarrhea)which, according to experts, decreases over time. Use is possible from 18 years of age.
One of the most troubling challenges in treating obesity is maintaining the reduction achieved over time. On this topic, Katz pointed out that there is research showing that even stopping the medication is possible 60% of the weight lost is retained. “The maintenance dose has not yet been determined,” he clarified, “there are more and fewer patients who respond to it. Importantly, 94% of patients respond to some of the doses. And a reduction of more than 20% is necessary to achieve goals such as remission of diabetes or prediabetes.”
“From a cardiovascular point of view, obesity was not considered an independent risk factor, but now it has been shown that it is directly related to these risk factors,” explained cardiologist Jorge Tartaglione, former president of the Argentine Cardiological Foundation (FCA) –. And work on this dual-action drug shows not only weight loss, but also a decrease in waist circumference, fatty liver disease, blood pressure and heart failure. To put it in colloquial terms, what GIP and GLP-1 is “‘talk’ to the pancreas, helping it absorb the energy and telling it how to use it.”
Both Katz and Tartaglione agreed Medications should be prescribed for life. “Nobody is afraid to take antihypertensives or statins to lower blood pressure or cholesterol levels,” said the cardiologist. “These are chronic diseases that require long-term treatments. Obesity is also chronic.”
There was an unusual guest at the drug presentation: intensive care doctor and obesity specialist Shiry Attie from Cemic took part in the clinical study in which tirzepatide was tested on some Argentine patients. Attie, a mother of three, said that she weighed almost 100 kilos and that with these injections she managed to lose more than 30 kilos in 18 months.
“I’ve had weight problems my whole life, I lost weight and gained it back and I always had the feeling that the problem was not simply a lack of will – he admitted –. During the pandemic, my work as an intensive care physician was very hard; I felt like I was at war. Since using these injections, food is no longer a constant thought in my life. And my overall health improved, both physically and mentally.”
In Argentina, statistics show that more than 6 out of 10 adults are overweight and/or obese and 4 out of 10 children and adolescents between the ages of 5 and 17 are overweight. Mónica Katz also said that the costs resulted from this Addressing the problem (not only obesity, but also its numerous complications) affects more than 2.5% of GDP.
Drugs that have come onto the market in recent years to treat overweight, obesity and diabetes have not only been shown to lower the number on the scale. They have also led to improvements in the metabolic, cardiovascular, musculoskeletal and neurological profiles of people who use them.
Mid last October Nordisk introduced Wegovy (semaglutide), already marketed in the country under the name Ozempic, indicated for the treatment of type 2 diabetes at a dose of 1 mg/week. The difference from Ozempic, specifically indicated for overweight and obesity, is that it can be administered in a weekly dose, but up to 2.4 mg, which enhances its effect on satiety and appetite reduction.
A month later, the “overloaded” version of the local semaglutide appeared in our country: Obetide, from Elea laboratorysimilar to its predecessor Dutide, which, like Ozempic, was offered at a dose of 1 mg/week for type 2 diabetes, while Obetide, also injectable and indicated for overweight and obesity, allows the dose to be increased up to 2.4 mg/week.
Although the active ingredient and dosage are similar between the Danish and Argentine products, there is a large price difference between the two: four syringes of Obedite (for one month of treatment) cost $234,935.50 at the highest dose, while Wegovy costs $717,827.21. The four monthly doses (one per week) of Monjaro at 5 mg cost $783,858.40.
Javier Waistblat, laboratory manager AdiumRegarding coverage, stated that providers expressed a strong intention to cover the highest risk patients: “That’s what they said could in this way replace referrals to bariatric practicesas the drug is not only cheaper but also not an invasive procedure.”
Waisblat made that clear The laboratory will have a performance system with discounts of up to 30% and that “the comparison with other products does not seem fair because Mounjaro has a dual mechanism of action.”
With the obesity epidemic seemingly unstoppable, the World Health Organization (WHO) has issued a statement recommending the use of these drugs in adults with a BMI over 30 to treat overweight, obesity and diabetes, but with several warnings.
On the one hand it says The WHO estimates that a maximum of 100 million people could benefit from these drugswhich represents less than 10% of people with obesity in the world, and in this sense that they do not contribute to the increasing inequality of access (they are expensive drugs) and that they are taken with a doctor’s prescription along with a diet plan and physical exercise.
Also There are concerns about self-prescribing injections in people who do not suffer from obesity or diabetes, a reality recently reported in an article published in Obesity, which analyzes the phenomenon from a psychological and social perspective and warns that the expansion of consumption is proceeding faster than the generation of scientific data.
“The influence of celebrities, social networks, the availability of products and the connection between thinness, discipline and higher values create a kind of moral economy of the body that is not free from risks,” it said. The conclusions of this work highlight the need for interdisciplinary and intersectional research (spanning ethnicity, gender and social class) to understand the impact of these “Medicalization of thinness“.
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