It’s that time of the year for many people: a time based largely around food, drink, the sofa, and the television. It is also a time for reflection of what has been and what may be in the future. For most of us this means putting on a few pounds, getting hopeful about losing them, and then, after a short while, realizing it is much more difficult to lose those pounds than put them on. And this is quite a nice parallel for the obesity drug market: the obesity epidemic continues to have impacts physically, socially, and economically; the odd glimmer of hope raises expectation of a holy grail (a safe, effective, affordable pharmacotherapy for all who need it); and then the crushing realization that we are not any closer to realizing the dream. Almost makes you want to say, “Obesity medications? Humbug.”
As 2015 rolled into 2016, development of perhaps the most encouraging emerging therapies, Zafgen’s beloranib, was finally terminated due to adverse effects and death related to an increased risk of venous thromboembolism. Despite being an injectable therapy aimed at niche disease areas, beloranib appeared to deliver weight loss well in excess of 10% of body mass. This degree of efficacy is what is needed to really fill the gap between lifestyle modifications and bariatric and metabolic surgery. The successful launch of such a drug would be like Christmas day every day for the developer.
As of 2016, the United States has a small group of medical therapies: phentermine, orlistat, Arena/Eisai’s Belviq, Vivus’s Qsymia, Orexigen’s Contrave, and Novo Nordisk’s Saxenda; in Europe and Japan pharmacotherapeutic options are much more limited. All of the agents have suboptimal risk-benefit profiles or are relatively (or even very) expensive. The only real positive appear to be the roll out of Orexigen’s product (also known as Mysimba) around the world, including Europe. However, the limited efficacy of this drug and its relatedly high cost have not been able to stimulate significant shifts in prescribing practices. Moreover, the ongoing delays with completing a cardiovascular outcomes trial could have commercial repercussions in the future. Rhythm Pharmaceuticals’ setmelanotide has demonstrated positive data but in only a few patients with niche disorders. Research continue to churn out data on potential pathways, but this might just highlight the crux of the matter. The body has so many pathways aiming to conserve energy, the hope of a single agent being the silver bullet is small.
So, 2016 has resembled many other years for the obesity market: limited treatment options, new pathways have been identified, and we remain fat. More Groundhog day than Christmas Day, if you ask me. Humbug.