A new obesity jab that sparked a diabetes row in the US is now being considered for wider use by the UK health service.
Tirzepatide, from Eli Lilly and Company, is currently approved by regulators for type 2 diabetes – but may soon also be approved to treat obesity.
The weekly jab, sold under the brand name Mounjaro, is the successor to celebrity-endorsed Ozempic — a diabetes drug that shot to fame on TikTok for helping people lose weight rapidly. Now, the National Institute for Health and Care Excellence (Nice) is seeing whether the drug would be a good use of NHS funds.
Ozempic is a version of semaglutide. That drug mimics a key gut hormone, known as GLP-1, that is activated after people eat, boosting the release of insulin and slowing release of sugar from the liver. It delays digestion and reduces appetite, making people feel full longer.
Tirzepatide is the first drug that uses the action of two hormones, GLP-1 and GIP, for greater effects. It also targets the chemical signals sent from the gut to the brain, curbing cravings and thoughts of food
When Mounjaro came on the market in the US, people flocked to buy the drug thanks to a coupon that allowed them to access it for just $25 a month.
Then the coupon disappeared. With people unable to afford to sustain their use of the jab, coupled with shortages of Mounjaro, a row erupted between people with type two diabetes, patients with obesity and those people looking to lose weight.
Nice has already approved Wegovy – a weight loss and management drug – for use on the NHS for obesity. And, in the near future, it will either recommend or reject Mounjaro for broader use across the UK health service.
In a new study, presented at the European Congress on Obesity in Dublin but not yet peer-reviewed, researchers conducted an analysis of 2,539 adults who were overweight or obese and had at least one weight-related complication, excluding diabetes.
They were split into groups to either receive a placebo drug, or 5mg, 10mg or 15mg doses of tirzepatide.
The proportion of people who lost weight compared with the start of the study, and those who lost more than 5 per cent of their body weight in total, were assessed across BMI categories 27 to 30, 30 to 35, 35 to 40 and 40 and over.
Body composition was also evaluated in a smaller group who underwent specialised scans to look at their fat mass and their lean mass.
At the start of the study, people typically weighed more than 16st (104.8kg) and had a BMI of 38.
The average body weight loss after 72 weeks of weekly injections was 16 per cent for the 5mg dose group, 21 per cent for the 10mg and 23 per cent for the 15mg group.
This compared with a 2 per cent loss on placebo.
The proportion of people who lost 5 per cent or more of their body weight was 89 per cent on the 5mg dose, 96 per cent on the 10mg and 96 per cent with 15mg.
This compared with 28 per cent on the placebo.
Furthermore, more than half of people (56 per cent) in the 10mg group and 63 per cent in the 15mg group lost a fifth or more of their body weight compared with 1 per cent on placebo.
All doses of the drug led to weight loss regardless of original BMI.
Experts also looked at a small sub-set of people to see how much fat they lost compared with how much (non-fat) lean body mass.
They looked at these findings in people aged under 50, 50 to 65 and over 65 years of age.
The team said only a quarter of the weight lost was lean mass, resulting in an overall improvement in body composition.
Across the age groups, the change was almost identical, suggesting there was no evidence of excess lean mass loss in older people, they added.
The authors said: “In this 72-week trial in participants with obesity, tirzepatide once weekly provided substantial reductions in body weight, consistent across all BMI categories, with improvement in body composition that was clinically meaningful and consistent across age groups.”
Dr Louis Aronne, from Weill Cornell Medicine in New York and a consultant to Eli Lilly, who presented the findings, said there was a need to understand the effect of weight loss on fat mass and lean mass, particularly in the elderly.
He added: “This new analysis shows that around three quarters of the weight lost was fat mass, which is consistent across different ages.”
Research published by Eli Lilly in the last month showed tirzepatide helped people with type 2 diabetes who were overweight or obese lose up to 16 per cent of their body weight, or more than 34lb, over nearly 17 months.
With additional reporting from the Press Association
