Lilly, Novo Nordisk's weight loss meds could replace surgery for obesity patients: specialist

Take a weekly subcutaneous injection or undergo invasive, risky and costly stomach surgery?

After Eli Lilly presented head-turning weight loss data earlier this week for its tirzepatide, the question is pertinent.

An obesity specialist and MEDACorp key opinion leader, who was consulted by SVB Securities, believes that the data are so compelling that the drug could in many circumstances replace sleeve bariatric and gastric bypass surgeries—often seen as last resorts for those who are morbidly obese. Tirzepatide recently won FDA approval in type 2 diabetes as Mounjaro.

Data presented by Lilly at the American Diabetes Association’s annual conference showed that patients lost an average of 16% of their body weight on a 5-mg dose of tirzepatide and an average of 21.4% and 22.5%, respectively, on the 10-mg and 15-mg doses of the treatment.

“The impressive weight loss seen with tirzepatide surpassed the previous mid-teens expectations of key opinion leaders,” SVB analysts wrote in a note to clients.   

For the study, investigators tested weekly tirzepatide versus placebo for 72 weeks.

The obesity specialist pointed out that the weight reduction achieved with tirzepatide is favorable to results achieved with sleeve gastrectomy surgery (20%) and approaches weight loss results with gastric bypass (25% to 30%).

The specialist also pointed to the greatly reduced risk profile of the pharmaceutical option. Among those who undergo those surgeries, 5% to 10% suffer serious complications. The procedures also are costly, going for upwards of $35,000.

“Bariatric surgery complications can cause patients to be in and out of health systems for life, driving a heavy cost burden on the U.S. healthcare system,” SVB analysts wrote.

The specialist said that the availability of tirzepatide and Novo Nordisk’s Wegovy—which is specifically prescribed for weight loss—will compel doctors to be more selective about which obesity patients are appropriate for surgery.

In addition, the specialist told SVB that weight loss achieved with GLP-1 drugs will be more durable than diet and lifestyle changes.

The specialist also expects that future readouts for cardiovascular outcomes for the Lilly and Novo drugs will be “highly positive” and drive expanded payer coverage. He added that doctors will “definitely” use tirzepatide off-label for prediabetic obesity patients.

“For every type 2 diabetic seeking treatment out there, there are easily twice as many prediabetics out there,” SVB analysts wrote, paraphrasing the specialist.