Saxenda and Ozempic

-Summary:

Saxenda and Ozempic are GLP-1 receptor agonists. Saxenda is approved as a weight loss medication, while Ozempic is indicated for the treatment of type 2 diabetes.

Some of the differences between Saxenda and Ozempic are the intended uses, cost and posology.

In terms of weight loss, Saxenda does not appear to produce more significant weight loss than Ozempic and it may be the other way around,which remains to be proven.

-Development:

Both drugs, liraglutide(saxenda) and ozempic (semaglutide) are both incretin mimetics, a natural hormone with a short half-life and therefore ineffective for weight loss.

This is when the concept of combining a glucose-dependent insulinotropic polypeptide alone or in combination with a glucagon-like peptide 1 (GLP-1) receptor agonist was born.

This leads to incretins having great therapeutic potential in the treatment of diabetes mellitus and obesity.

This combination has a solid basis in pathophysiopathogenic fundamentals. Glucose-dependent insulinotropic polypeptide is produced by intestinal K cells.
Like GLP-1, it is released in response to nutrient ingestion and promotes insulin secretion through receptor binding on pancreatic beta cells.

It also exerts a clear modulatory effect on glucagon by inhibiting its secretion in states of hyperglycemia (high blood glucose) but increasing glucagon release in states of hypoglycemia (low blood glucose).
Co-treatment with a glucose-dependent insulinotropic polypeptide and a GLP-1 receptor agonist would increase glucose lowering while decreasing the risk of hypoglycemia.

Therefore, in patients with type 2 DM, combination therapy with incretins would provide better efficacy in blood glucose control than treatment with a GLP-1 receptor agonist alone, while avoiding episodes of hypoglycemia.

In a recent paper Frias and colleagues ( N Engl J Med 2021;385:503-515.) report the clinical results of combined incretin therapy with tyrzepatide, a dual insulinotropic polypeptide.

This means that it acts as both an incretin and a GLP-1 receptor agonist, as compared to semaglutide (a GLP-1 receptor agonist), in patients with type 2 DM. The trial participants, like many patients with type 2 DM, were overweight or obese.

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist being developed for the treatment of type 2 diabetes.

The efficacy and safety of tirzepatide administered once weekly compared with semaglutide, a selective GLP-1 receptor agonist, is unknown at this time.

-Conclusions:

All of them act by producing satiety, throughout the day, with which food ceases to be, as in many cases an act to calm anxiety, stress, distraction etc. etc. etc.

Therefore, they are useful to control obesity in adult patients with a body mass index (BMI) equal or higher than 30 kg/m2.

In certain cases with an index equal to or higher than 27 kg/m2, if you suffer from arterial hypertension, type 2 diabetes or an elevated level of cholesterol, triglycerides or a low level of HDL cholesterol, generally of genetic origin, type 2 diabetes, or arteriopathy.

In both cases, progressive doses are used, which are increased according to needs and tolerance and are for subcutaneous application.

Recently Rybelsus has been marketed, which is ozempic daily in tablets, at the beginning during one month the dose is 3mg. at breakfast, the following month the tablet will be 7mg. and in the third month 14 mg.

The cost is always the same and with an attractive ratio of results versus price.

Diabetes is a chronic disease, currently in Spain there are about six million people with diabetes and most of them belong to type 2.

This disease is also associated with aging and obesity, which are two other great pandemics of mankind.

Fifty percent of diabetics (type 2) have obesity, a percentage that increases to 80 percent if we talk about overweight, about half of whom are unaware of it.

On the other hand, around 50 percent of the Spanish population is overweight, a figure similar to that of the United States, where the number of morbid people is higher.

-O’Neil PM, Birkenfeld AL, McGowan B, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity. Lancet. 2018;392:637-649.

-Frías et al.N Engl J Med 2021;385:503-515.

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