Diabetes Dialogue: "Second-Generation" Obesity Medications, with W. Timothy Garvey, MD

With Eli Lilly and Company announcing the completion of their submission to the US Food and Administration for a chronic weight management indication for tirzepatide (Mounjaro), the medical community is looking ahead towards a potential approval. This excitement is driven, in part, by the phase 3 data from the SURMOUNT-2 trial presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023).

"People living with type 2 diabetes in many cases have been exposed to excess weight for years and often face increased difficulties in achieving weight loss results, typically losing 30% less weight than those who have obesity without type 2 diabetes. They need options to help overcome those challenges and achieve meaningful weight reductions," said principal investigator W. Timothy Garvey, MD, professor of medicine and director of the Diabetes Research Center at the University of Alabama at Birmingham. "Tirzepatide not only helped people achieve body weight reductions of up to 15.7%, but also helped to significantly lower A1C without severe hypoglycemia and led to improvements in other cardiometabolic endpoints."

Published in The Lancet, results of the trial, which included patients with type 2 diabetes overweight or obesity, suggest use of tirzepatide in 10 or 15 mg doses were associated with mean body weight reductions of 12.8% and 14.7% at 72 weeks, respectively, compared to a mean weight reduction of 3.2% with placebo. When assessing proportion of patients achieving respecified weight loss thresholds, results indicated body weight reductions of 15% or greater and 20% or greater were achieved by 51.8%and 34.0%, respectively, among the tirzepatide 15 mg group. Further analysis of secondary endpoints from the trial indicated use of tirzepatide was associated with a mean reduction in weight circumference of 11.2 cm and 13.8 cm with the 10 and 15 mg doses, respectively, compared to 3.4 cm with placebo.

With an interest in learning more about the trial and how it informs clinicians on use of tirzepatide, hosts of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, sat down with Garvey for a special edition ADA 2023 episode. During the episode, Garvey discusses the results of SURMOUNT-2 and takes a deep dive into other topics, including why he is concerned over the growing prevalence and use of online clinics.

Relevant disclosures for Dr. Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. Relevant disclosures for Dr. Garvey include Boehringer-Ingelheim, Novo Nordisk, Eli Lilly and Company, Merck & Co., Inc., Alnylam Pharmaceuticals, Inc., Fractyl Health, Inc., Inogen, Epitomee, Pfizer Inc., and Neurovalens.

References:

1. Lilly’s surmount-2 results published in the Lancet show Tirzepatide achieved a mean weight reduction of 15.7% at the highest dose (15 mg) in adults with obesity or overweight and type 2 diabetes. Eli Lilly and Company. June 24, 2023. Accessed June 28, 2023. https://investor.lilly.com/news-releases/news-release-details/lillys-surmount-2-results-published-lancet-show-tirzepatide.
2. Garvey WT, Frias JP, Jastreboff AM. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. The Lancet. Published online June 26, 2023. doi:10.1016/S0140-6736(23)01200-X