The Complex Usage and Impact of GLP-1 Usage: Q&A with Mark Bagnall

GLP-1 drugs continue to dominate the pharmaceutical landscape. The medication is popular for its weight loss applications, and major pharmaceutical companies continue to introduce new versions of these medications. In late March, FDA approved a high dose injectable version of Wegovy through its accelerated approval program. Around the same time, Novo Nordisk announced a new multi-month subscription program for Wegovy for telehealth providers.

Clearly, the drugs are still popular. However, new data collected by Phenomix and the Mayo Clinic suggests that patients seeking the drug may not be fully aware of how the medication works and what the side effects are.

Phenomix’s CEO Mark Bagnall spoke with Pharmaceutical Executive about this data and what the impact is on GLP-1 users.

See the video version of this interview here!

Pharmaceutical Executive: Why do a significant number of GLP-1 users stop taking the medication in the first year?
Mark Bagnall: In our experience, it's a combination of the cost of medication and unforeseen effects. A lot of folks who start using the drug think of it as a panacea. It's going to be easy. My friend lost 30 pounds, I'm going to lose 30 pounds too.

However, a number of people (between 10-20%) suffer from severe side effects, such as nausea, vomiting, etcetera. Another fairly significant number of people just don't see the weight loss that they would like to have seen. Some may see a little bit, but some of them, unfortunately, see none.

That combination is expensive. People who say, “I'm struggling with side effects,” or “I'm not really seeing enough weight loss” will tend to stop using the medication. This is unfortunate, because it has cost them some money and some time.

There are people who have struggled with managing weight for a long time, and to have thought that you could eventually see a benefit than not seen it must be awfully disappointing.

Pharmaceutical Executive: How many GLP-1 users must seek medical care for side effects?
Mark Bagnall: The survey we did was quite surprising with the extent of the side effects. I've seen other publications and other surveys that suggest that side effects are affecting 30-40% of patients, maybe more than that. We have before seen 50-60% of patients really struggling with these side effects.

What was surprising is the degree to which these side effects were costing patients. A large number of patients are spending about $1,000 in out-of-pocket costs just to manage the side effects. That seemed like a lot, but the fact that there were 10% of patients who were spending $5,000, that's a lot.

The fact is that is what we're now seeing. The cost of a year supply of drugs and these over-the-counter markets is about $5,000. A significant number of patients spend $5,000 just managing side effects. That was a really surprising finding, and if you translate that into the total number of people who could potentially use a GLP one medications, that's just an unsustainable number.

Pharmaceutical Executive: What unexpected costs do GLP-1 patients face?
Mark Bagnall: People in the weight loss industry have always tended to focus in on total weight loss. “I lost 50 pounds.” That's great, but what we have not done a good job of, at least until fairly recently, is thinking about what that means in terms of body composition.

So, the side effect that is most troubling is loss of muscle mass, and it's troubling because all sorts of issues arise from loss of muscle mass. It is our muscles that are the greatest consumers of energy. So, less muscle mass, less basic metabolic utilization of fatty acids and glucose that circulate in our system. That's bad.

Also, for older folks, they really cannot afford to lose that muscle mass because risk of falls, fractures, etc, go up. One of the things that we now must think about is those other effects of GLP 1s.

One of the surveys we did suggests that patients are becoming aware of those, but that understanding of those risks is not universal. Those of us who are in the business owe it to patients to let them be fully aware that these risks exist. That’s not to say that these drugs haven't been quite remarkable in their effect, but we just need to understand better.

Pharmaceutical Executive: How does the complexity of obesity impact the effectiveness of GLP-1s?
Mark Bagnall: This is one of the reasons we started Phenomix: the understanding that obesity is a very complex disease. The reason that people suffer from this disease varies, and the complexity of these is that there are many factors that contribute.

There four basic subtypes of obesity. The first we call hungry gut folks, who tend to snack between meals. The second are hungry brain folks, who tend to overeat at a single seating. The next category is emotional , who eat because of emotion. Last is slow burn, who just don't burn enough energy.

What that means is that we must think through how we customize therapies and interventions to each individual, and it may well be that a GLP-1 is not the right drug for you. Or it may well be that a GLP one is the right drug for you, but must be combined with resistance training, because resistance training and protein will enhance muscle mass as I take the GLP one.

What we do know through the work we're doing on the genetics of the disease is that it's far more complex than a single answer, a single intervention, a single drug, would solve for all the population.