The GLP-1 medications have become deeply ingrained in our culture, thanks to extensive marketing efforts and a surge of social media posts, making many people aware of their potential for significant weight loss in those who are overweight. But often lost in the conversation is awareness of other oral anti-obesity medications (AOM) that have demonstrated moderate clinical success and are available at a much lower cost than their GLP-1 counterparts.
The most common weight loss medications outside of the GLP-1 category:
- Orlistat: Works by reducing the amount of fat that is absorbed, leading to weight loss. Orlistat is available over-the-counter (Alli®) and in prescription strength (Xenical®).
- Phentermine: A generic stimulant medication that suppresses appetite and increases feelings of fullness. It is typically used for short-term management of obesity.
- Phentermine/Topiramate (Qsymia®): Combines phentermine, an appetite suppressant, with topiramate, an anticonvulsant medication.
- Bupropion/Naltrexone (Contrave®): This combination medication includes bupropion, an antidepressant, and naltrexone, a medication used to treat opioid addiction.
Before GLP-1 medications were introduced, AOMs were prescribed less frequently due to their side effects and modest weight loss. The initial clinical studies showing over 15% weight loss with GLP-1s quickly shifted the focus away from other alternative options.1
Comparison of study results for GLP-1s & AOMs
Recent real-world evidence of persistence issues, side effects, and modest weight loss in GLP-1s suggests that alternative AOMs may be a more cost-effective treatment option or or as a first-line agent within a step-therapy protocol, which requires patients to try lower-cost medications before accessing more expensive treatments.
No head-to-head studies currently compare the efficacy of GLP-1s to Qsymia, but we can compare results of the individual studies. Researchers found that the use of semaglutide (Wegovy®) resulted in 14.9% weight loss at 68 weeks, with 69% of participants losing at least 10% of their starting weight.2 In contrast, the CONQUER study for Qsymia® showed weight loss of 8-10% after 56 weeks, with 48% losing at least 10% of their starting weight.3 While side effects differ (including dry mouth, insomnia, and dizziness), both medications have similar discontinuation rates
These studies suggest that anti-obesity medications (AOMs), particularly a less costly oral medication, may be a viable treatment option for certain patient populations, especially those with a lower BMI who do not need to lose significant weight.
Plan sponsors should assess the following key considerations:
- Engage with your pharmacy benefit managers to discuss the formulary options available for anti-obesity medications. PBMs can provide information on the cost, coverage, and utilization management strategies associated with different medications, including those used as first-line treatments.
- Transparent communication with employees is essential when considering alternative anti-obesity medications. Plan sponsors should ensure that employees have resources available to understand their anti-obesity treatment options, including coverage and cost.
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Sources:
- “Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial, Nat Med, accessed September 19, 2024, https://doi.org/10.1038/s41591-022-02026-4.
- John PH, et al., “Once-Weekly Semaglutide in Adults with Overweight or Obesity,” The New England Journal of Medicine, accessed September 19, 2024, https://www.nejm.org/doi/full/10.1056/NEJMoa2032183.
- Gadde KM, et al., “Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomized, placebo-controlled, phase 3 trial,” The Lancet, September 19, 2024, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60205-5/abstract.
