- Taking
tirzepatide (Mounjaro and Zepbound) long-term may be critical for
maintaining weight loss promoted by the drug, a new study finds.
- Both
people taking the drug and a control group taking a placebo maintained
some weight loss during the study period, but those on the drug kept more
off or lost additional weight.
- Researchers say the study underscores the importance of making lifestyle changes in tandem with weight loss drugs.
People who continue to
take the weight loss drug tirzepatide experience better results both with
losing weight and keeping it off compared to those who take the drug for a
limited duration, a
Previous phase three clinical trials showed that
tirzepatide, which is sold under the brand names Mounjaro and
the recently approved
Zepbound, resulted in a 20% or greater weight
loss after 72 weeks compared to a control group that was taking a placebo.
This new phase three trial took 670 participants and
lasted a total of 88 weeks. All participants received treatment with
tirzepatide for 36 weeks. Then, participants were randomly assigned to either
an an additional year of treatment or to a placebo injection.
The researchers reported that those who remained on
the drug lost an additional 5% of their total weight, adding up to around 25%
overall. While the placebo group maintained some weight loss although they
gained 14% of their weight back, the researchers at the Weill Cornell Medicine
and NewYork-Presbyterian in New York reported.
The study was sponsored by Eli Lilly and Company, the
manufacturer of both Mounjaro and Zepbound.
However, tirzepatide differs from semaglutide in some
important ways.
“Tirzepatide is a single molecule that binds to and
activates not only the GLP1 receptor but also a second receptor—the
glucose-dependent insulinotropic polypeptide (GIP) receptor,” explained Dr.
Dan Maselli, an obesity medicine physician and bariatric endoscopist
at True You Weight Loss in Atlanta who was not involved in the study.
“GIP receptor activation has similar effects as
activation of the GLP1 receptor, and the synergistic effect from this
dual-binding likely explains why weight loss from tirzepatide is more
significant than weight loss from semaglutide,” he told Medical News
Today.
Experts say that additional weight loss benefit could
help people feel like it’s worthwhile to stay on the drug.
“This study is consistent with other studies that
there is a high rate of recidivism with weight loss patients when they stop
medication,” said Dr. Mir Ali,
a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss
Center at Orange Coast Medical Center in California who was not involved in the
study.
“Studies have shown that
tirezepatide has more weight loss than other medications, even Ozempic. When
patients see good weight loss results, they are more likely to continue the
treatment plan,” he told Medical News Today.
This drug, as with other similar drugs, sees most of the weight
loss in the initial months after starting treatment.
After that, losses are incremental, so a study
demonstrating the importance of remaining on the drug for weight loss
maintenance is critical, experts say.
“The trial was instructive about the capabilities and
limitations of tirzepatide,” Maselli said. “We can see here that over the
course of the following year, subjects continue not only to lose weight but
also see improvements in measures of cardiometabolic disease — such as insulin
resistance (e.g. hemoglobin A1c), cholesterol, body mass index, and waist
circumference. In concert, these findings show that tirzepatide is a formidable
tool for those seeking treatment for obesity.”
What doctors
thought about the Mounjaro study
However, while it might be tempting to say that it’s not a
surprise that a study sponsored by a drug manufacturer might find that staying
on the drug long-term is the best course of action, most experts consulted said
the quality of the study was sound.
“This study was sponsored by and written mostly by Eli
Lilly employees and the lead and other authors also have very strong ties to
the pharmaceutical industry with many conflicts reported,” noted Dr. Meredith Warner, a Baton Rouge,
Louisiana, orthopedic surgeon and founder of The Well Theory who wasn’t
involved in the study.
But overall, Warner told Medical News Today, “the study had good power and
there seem to be no issues with the statistical analysis.”
Instead, the study in part affirmed what doctors say
they already know about weight loss.
“[The study] reinforced that obesity is a chronic,
complex, progressive, and relapsing disease state and that these medications
are treatments but not cures,” Maselli said. “By the time the 88 weeks was up,
subjects in the placebo arm from week 36 to 88 had regained over half of the
weight they had lost from weeks 0 to 36 on the tirzepatide. This underscores
what medical professions in obesity medicine have understood in the wake of the
semaglutide literature: these medications must be continued long-term to
sustain improvements in weight and cardiometabolic disease.”
“This, of course, is frustrating for patients to hear,
as many are looking to truncate and not add to their medication list, least of
all for a medication that, in the current landscape, is associated with
significant out-of-pocket expense and supply disruptions that lead to
unpredictable access.”
That said, lifestyle changes also play an important
role in restoring metabolic health, and no drug or medical procedure is a
cure-all.
“No matter what intervention is employed, if the
patient does not make permanent, long-term dietary and lifestyle changes, they
can regain weight,” Ali said. “Medications and surgery are tools to help
patients make these changes; like any other tool if used properly, it can work
well.”
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