Highlights
- •Obesity pharmacotherapy is needed to meet clinical needs currently unmet
- •Existing anti-obesity medications do not meet double-digit weight loss that is often required especially in those with severe obesity
- •Many new druggable targets have been identified as knowledge on body weight control increases
- •GLP-1 and GLP-1/GIP compounds offer weight losses ≥ 15% and are well advanced in clinical trials
- •Regulatory approval pathways need updating to meet current concepts of obesity as a chronic disease
- •Treatment guidelines will need to evolve as more anti-obesity medications become available
Abstract
There is a growing unmet need for more effective treatment of obesity and its complications.
While current anti-obesity medications are effective and offer real clinical benefits
over diet and lifestyle interventions, they cannot meet the levels of efficacy and
reduction of hard endpoint outcomes seen with bariatric surgery. As knowledge on the
control of body weight unravels, the complexity of this physiology opens the opportunity
to new druggable targets. Currently, gut peptide analogues such as semaglutide, a
glucagon like peptide-1 (GLP-1) receptor agonist, and the dual agonist GLP-1 and gastric
inhibitory polypeptide (GIP) tirzepatide are the furthest advanced in clinical development
and seem likely to meet current regulatory requirements within the next year or so.
However, current regulatory requirements are out of step with the efficacy of new
compounds and concepts relating to obesity and its complications. Many other drugs
in early development will target different pathways of energy balance, raising the
possibility of drug combinations to maximise efficacy as for other chronic disease
such as hypertension and diabetes. This will allow more complex and personalised guidelines
to evolve.
Keywords
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Article info
Publication history
Published online: May 20, 2021
Accepted:
April 22,
2021
Received in revised form:
April 15,
2021
Received:
November 25,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
