A comparison of two drugs used to treat type 2 diabetes found that tirzepatide (Mounjaro) was superior to semaglutide (Ozempic) at blood sugar control (glucose) and promoting weight loss.
A meta-analysis of 22 randomized controlled trials were just presented at the annual meeting of the European Association for the Study of Diabetes in October.
Of the 22 trials included in the meta-analysis, two involved direct comparisons between semaglutide and tirzepatide. The other 20 trials compared either semaglutide or tirzepatide with another item for comparison, such as an inactive placebo. These studies provided indirect comparisons of the results between semaglutide and tirzepatide. The studies used in this meta analysis lasted at least 12 weeks. These studies included data from 18,472 patients with a diagnosis of type 2 diabetes. Tirzepatide (Mounjaro) and Semaglutide (Ozempic) are medications which are FDA approved for diabetes management but are being used by physicians and their patients “off-label” for weight reduction.
- The comparison between the two drugs showed that Weight loss was greater with tirzepatide, and there was a slight advantage of the drug for blood sugar control.
The science behind these these drugs:
Semaglutide belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. It mimics the GLP-1 hormone, which is released in the gut in response to eating.
Tirzepatide also mimics the GLP-1 hormone, as well as the glucose-dependent insulinotropic polypeptide (GIP), another hormone released after eating.
The dual action of tirzepatide is thought to be the reason that some studies show it is more effective for blood sugar control and weight loss than single-acting drug like semaglutide
BLOOD SUGAR REDUCTION
BODY WEIGHT REDUCTION
Reductions in body weight were greatest with the highest dose of tirzepatide. In a news release the authors state, “In summary, the three tirzepatide doses were more effective than the three respective semaglutide doses, with the difference between the two drugs being larger with the higher doses.”
When the two drugs were compared directly, the high and medium doses of tirzepatide resulted in more weight loss than all three doses of semaglutide.
In July, drug maker Eli Lilly announced results from two trials of tirzepatide (Mounjaro) in adults who were overweight or had obesity, excluding those with type 2 diabetes. These showed that people lost around 26% of their weight after 84 to 88 weeks, using a dose of 10 or 15 milligram. Eli Lilly is applying to the FDA to get approval for Mounjaro as a weight loss drug in addition to its approval for diabetes.
NEGATIVE SIDE EFFECTS
All doses of semaglutide and tirzepatide increased the risk of nausea, vomiting and diarrhea compared to placebo. The highest dose of tirzepatide was associated with the greatest increased risk of these gastrointestinal side effects. The best regimen for any individual needs to be determined in conjunction with their physician. Patients who wish to take this medications should ideally seek to be under the care of a physician with experience in weight loss medicine.
REAL WORLD IMPLICATIONS
Dr. Caroline Messer is an endocrinologist at Lenox Hill Hospital in New York City. She says that the weight loss seen in the studies included in the meta-analysis are similar to what she has seen in heclinic, finding tirzepatide producing greater weight loss.
Another important scientific finding for semaglutide was that it was shown to prevent cardiovascular disease. We are awaiting studies on tirzepatide to see if that same cardiovascular protection can be proven .
Also, the head-to-head trials of the two drugs only included patients with diabetes, so the results may be different for people using the drug primarily to lose weight.
Costs of these medications
Cost may also play a part in people’s decisions. Tirzepatide is significantly the more expensive of the two. And a person’s insurance may not cover the cost of the drug, especially if it is prescribed off-label. FDA approval of this drug would likely reduce costs for insured patients, although the portion of the cost- the out of pocket cost still remaining despite the insurance coverage, would still be too much for many people.
The great desire and need people have to lose weight, and the effectiveness of these medications has still resulted in a very great demand for them despite their expense. As Dr Messer says, “We have a lot of patients who don’t have diabetes, but are paying out of pocket…doing whatever they can to get hold of it because it’s so unbelievably powerful in terms of controlling impulses and hunger.”
Making the most of these medications for weight loss and diabetes control
For the best results anyone taking these medications should see the medication as a helpful tool to achieve their weight loss goals and diabetes control. They should not be seen as the total answer. A person should follow a dietary regimen that promotes weight loss. One of the most important elements in that diet should be to limit the intake of simple sugars. That’s best for both diabetes and for weight loss. If this is done, then either semaglutide (Ozempic, Wegovy) or Tirepatide (Mounjaro) may be a game changer and provide success the person has never achieved before. But a person who thinks that simply taking the prescribed medication is all they need to do, may find that they can undo the benefits of the medication. The assistance given by the medications is in their ability to reduce appetite and cravings, and also by providing a sensation of being full with less food than the person usually eats. However, if a person engages in the same unhealthy diet that they ate before they took the medication, they may easily undo the benefits of the medication resulting in little if any benefit from taking the medication. Similarly, engaging in exercise helps a person with their weight loss goals whether the diet involves taking these medications or not. And although people have had success without exercise while taking semaglutide or tirzepatide they would have better results if exercise was added into their regimen. Maintenance of weight loss should always be considered as a crucial part of the picture when anyone loses weight. A person who did not change their food choices and did not exercise, relying entirely on the medication for the weight loss will be much more likely to regain their weight when they stop taking the medication. When a person does engage in the lifestyle changes needed for maximum success, they are more likely to successfully battle weight loss regain when they stop the medication. And they will be excellent candidates for a temporary resumption of the medication to eliminate a modest , partial weight regain that often occurs after stopping the medication. This strategic intermittent use of either semagluide or tirzepatide is a way that these medications can be used for long term weight maintenance, without having to stay on the medication continuously forever.