There are some snags to the new drug for severely overweight liraglutide. You only lose a few kilos, have to inject it every day for life and it can cause side effects. On the other hand, it provides an opportunity for severely overweight people who are unable to lose weight, despite extensive lifestyle coaching. 12 questions and answers about this drug.
1 How does liraglutide work?
Liraglutide is an injection drug that is very similar to a hormone we make ourselves in the gut. This own hormone is called glucagon-like peptide analog, GLP-1 for short. The hormone helps control blood sugar levels – not too high and not too low. Liraglutide is therefore already in use as a drug against type 2 diabetes under the brand name Victoza. What is special is that it has been proven to protect against the nasty consequences of diabetes such as cardiovascular disease and kidney disease. In addition to liraglutide, there are more drugs that work in this way, such as exenatide, dulaglutide, lixisenatide and semaglutide.
In the general practitioner guideline, this type of medicine is advised if other diabetes medicines have been tried first and if you have a very high risk of serious cardiovascular disease. Special aspect of liraglutide: you get a feeling of satiety, which makes you less hungry. Diabetes often goes hand in hand with being overweight, so that’s a ‘pleasant’ side effect. The manufacturer has therefore investigated the drug against serious overweight (obesity), registered it under the name Saxenda and received a compensation.
2 How much do you lose?
3731 people took part in the study. They had a BMI greater than 30, or a BMI greater than 27 plus a risk factor such as high cholesterol or high blood pressure. The researchers looked at who had lost at least 5 percent of their weight after more than a year. Those were the successful dropouts. In the liraglutide group this was 64 percent. But it was also not small in the placebo group: 27 percent of the participants. Not surprising, because everyone had to participate in a combined lifestyle intervention, or a coaching program towards a healthy lifestyle. (Read more about it here) In concrete terms: the participants weighed an average of 106 kilos at the start and after more than a year it had dropped 8.4 kilos and after three years it was still 6.5 kilos.
3 Why do you have to stop if it doesn’t work after 3 months?
It doesn’t work for everyone. Most people lose weight in the first 3 months. So if you have not lost 5 percent of your weight after 3 months, you have to stop, because it does not work.
4 How long should you use it?
It was looked at whether people could stop the drug after a while, but then the lost weight came back. So you have to keep spraying it for life.
5 Do you also lose weight if you use it for diabetes?
Liraglutide is already on the market as a diabetes drug under the name Victoza. Saxenda and Victoza are actually both syringes with the same amount of liraglutide. But the dose of liraglutide in diabetes is up to half lower than in overweight. Whether you will lose that much weight has not been shown.
6 Why do you have to move when using?
The combined lifestyle intervention is not only important for the effect of Saxenda (after all, the placebo group in the study often lost weight with it), but also for the side effects. With Saxenda you can get an accelerated heart rate (tachycardia). This can especially affect you if the substance is not used in combination with an exercise program. So you really have to keep moving when you use this. By the way: with all GLP1 agonists, the heart rate increases.
7 Which side effects often occur?
Side effects include: nausea, diarrhea, constipation and vomiting. Sometimes that is a reason to stop the treatment. Injection site reactions, headache, dizziness, and hypoglycemia (low blood sugar) also occur. Read about all side effects here.
8 What are the rare side effects?
Unfortunately, these are serious: as mentioned the accelerated heartbeat (tachycardia), inflammation of the pancreas (pancreatitis), bile and gallbladder problems and kidney failure. Certain forms of cancer have also been seen in laboratory animals (melanoma, thyroid and pancreas). The latter has not been seen in humans, but epidemiologist Middelkoop expresses his concerns about it in the podcast of General Practitioner & Science.
9 What are alternatives?
More drugs of this type have been approved in type 2 diabetes: exenatide, dulaglutide, lixisenatide, and semaglutide. Liraglutide is the only drug from this group that has been approved for use against obesity, i.e. without diabetes. No weight loss has been shown with dulaglutide. But semaglutide has been shown in research to be even more effective in diabetes and weight loss than liraglutide. Because it is not officially approved for obesity, the doctor may not prescribe it for this, explains epidemiologist Middelkoop. Tirzapatide seems to work even better, but that drug is not yet registered for diabetes or overweight. So this is not available.
10 For whom is it reimbursed?
There is a difference between the package leaflet and the reimbursement. Saxenda is approved for people with a BMI over 27, with other risk factors, and those with a BMI of 30 or higher. That is also stated in the package insert. However, the reimbursement only applies from a BMI of 35 in combination with sleep apnea, osteoarthritis or cardiovascular disease or a BMI higher than 40. Read more about it here. If you want to try it, you first have to work with a combined lifestyle intervention for a year. If you don’t lose 5 percent with that, you only qualify. If your BMI is in between, paying yourself is an option, but it is very expensive. The costs are 2600 euros per year, according to the Healthcare Institute.
11 Does liraglutide (Saxenda) also help against the risks of cardiovascular disease?
Indeed, the risk of cardiovascular disease decreases in people with diabetes. But this has not been demonstrated in people without diabetes who are only overweight, according to epidemiologist Middelkoop. For this we have to wait for more research.
12 Why is the arrival of Saxenda as a medicine against obesity good news?
No one can explain this better than Liesbeth van Rossum, professor of obesity. Well, there are some downsides to Saxenda, but it’s a breakthrough nonetheless, this is how she indicates to the Zorginstituut. Until now, doctors have been inclined to wait until someone who is overweight develops diseases, such as diabetes or cardiovascular disease, before taking action. That will now change, according to Van Rossum. Doctors can offer something for the first time, in addition to major stomach surgery. Overweight people can now also be referred to a combined lifestyle intervention and they can try this drug. Two more drugs will soon be added, Mysimba (in tablet form) and semaglutide (under the name Wegovy), which works even better than liraglutide.
Sources: Pharmacotherapeutic Compass, EMA, General Practitioner & Science, National Health Care Institute
