Blockbuster medications like Ozempic and Wegovy revolutionized the world of weight loss.
Experts estimate that medicines alone will increase US GDP by $360 billion by making workers more productive and healthy.
And despite growing evidence of long-lasting side effects such as diarrhea, stomach paralysis and suicidal thoughts, growth continues.
Weight loss experts are now predicting what the next chapter for Ozempic and Wegovy will look like, such as the drugs becoming available in cheaper pill form or a genetic alteration that eliminates the need for medications altogether.
Speaking this week at a health conference hosted by the Wall Street Journal in Boston, Dr. Florencia Halperin, an endocrinologist and medical director of Form StatusHe said there is a “tremendous pipeline of drugs” in development that could optimize or even eventually replace Ozempic.
Experts told DailyMail.com that new forms of weight-loss drugs could appear in the coming years, including cheaper pills and gene editing.
Weight loss medications like Ozempic and Wegovy mimic the production of the hormone GLP-1, which helps keep the body full.
Currently, Ozempic and Wegovy use the active ingredient semaglutide to mimic the production of glucagon-like peptide 1 (GLP-1), a protein that activates hormones in the brain to signal the stomach that it is full.
“We have known about GLP-1, a hormone produced by intestinal cells, since the 1980s, and that has paved the way for the development of GLP-1 receptor agonist drugs,” he told DailyMail.com.
«But weight regulation is very complex and GLP-1 is not the only pathway that controls weight regulation. “There are other types of opportunities to develop drugs and other targets.”
However, there are risks to targeting certain hormones, as they can cause a variety of strange side effects. For example, some patients have reported less desire to drink alcohol or gamble.
While upcoming treatments are in various stages of testing, Dr. Halperin said options such as oral GLP-1 agonists and those that target other hormones could hit the market in a short period of time. “I can assume it will be next year,” he said.
However, he noted that broader treatments, such as gene editing, could take several years to become available to the public.
She estimates that at least 70 treatments are in development.
GLP-1 agonists are already beginning to evolve rapidly: The newest injection, Zepbound, was approved by the Food and Drug Administration (FDA) in November.
The medicine contains the active ingredient tirzepatide, which is also found in Mounjaro. It not only targets GLP-1, but also the hormone glucose-dependent insulinotropic polypeptide (GIP), which experts believe could also improve the way the body breaks down sugar and fat, as well as reducing appetite.
Dr. Christopher McGowan, a gastroenterologist who runs a weight-loss clinic in Cary, North Carolina, told NBC News at the time, “This is the most effective form of pharmaceutical obesity treatment ever created.”
Like Wegovy, Zepbound is also approved for obesity, while Ozempic is only approved for type 2 diabetes.
However, the long-term effects remain to be seen. For example, a study published in December found that patients taking Zepbound gained 20 pounds more weight than Ozempic after stopping the drug.
Dr. Halperin said several studies are currently underway to test drugs that could target up to three hormones at once, such as GLP-1, GIP and glucagon, which regulates blood sugar.
“These drugs are sort of layers that target early mechanisms within a compound,” he said. “And then there are other drugs that target completely different pathways.”
The goal of many of these, which are in rodent testing, is to preserve muscle mass, as some research suggests that Ozempic and Wegovy cause muscle loss, especially in older adults.
New York-based Regeneron, for example, announced last month that it would begin testing a combination of Wegovy with an antibody treatment that blocks receptors that regulate muscle growth, according to Bloomberg.
“Preserving muscle mass is really important,” Dr. Halperin said.
He explained that muscle tissue is essential for regulating several different functions of the body, including basic movements such as walking and standing, as well as blood pressure. It also helps maintain bone health.
‘Preserving muscle mass is really important during weight loss because you don’t want to lose that healthy metabolic tissue. You want to maintain it or build it over time,” Dr. Halperin said.
Some patients have reported uncomfortable side effects while taking Ozempic, such as hair loss, diarrhea, and exhaustion.
He also pointed to an article published last year in the New England Journal of Medicinewho analyzed GLP-1 agonists made from small molecules.
Ozempic and Wegovy are biological medicines that come from natural sources such as plants and animals, rather than chemicals.
However, small molecule drugs are made from chemicals that are easier to produce, reducing their cost.
In the future, Dr. Halperin said this could provide a cheaper alternative to weight loss medications currently on the market, which can cost hundreds of dollars without insurance.
This would also mean that they could come in the form of pills rather than injections.
Dr. Halperin also said that scientists are working on creating a form of gene editing to help the pancreas make more GLP-1 on its own.
This would involve editing the structure of the body’s own genes so that they learn to produce GLP-1 and eliminate the need for medications.
He pointed to Massachusetts-based Fractyl Health, which filed preclinical results in December.
The Fractyl treatment, called Rejuva, was shown to reduce body weight by 27 percent in rodents.
The company said it plans to begin human clinical trials this year.
It also has the potential to last months or years at a time. For example, CRISPR, another recently approved gene-editing therapy for sickle cell anemia, lasts about a year.
However, Dr. Halperin cautioned that it is unclear how long clinical trials and possible FDA approval would take, and it could be several years before it is available to the public.
Still, he’s optimistic about what’s to come with obesity medications.
“It’s really exciting for patients who have obesity and need these treatment options,” he said.