Predicting weight loss after initiating pharmacotherapy to achieve successful weight management results--Lessons learned from the SCALE study
Glucagon-like peptide-1 (GLP-1) analogs mimic the naturally occurring hormone, whose main action is to stimulate insulin and inhibit glucagon production.1 In response to this vital role in metabolism, GLP-1 receptor agonists—liraglutides-- have been developed to regulate appetite and foods intake aimed to improve management of type 2 diabetes (T2D).
A liraglutide, (Saxenda, Novo Nordisk), was used in the Satiety and Clinical Adiposity Liraglutide Evidence in Nondiabetic and Diabetic People (SCALE) study to promote meaningful weight loss and delay the onset on T2D, by reducing levels of blood glucose, in conjunction with a healthy dietary regimen and regular physical therapy.2
“Since patients who were least motivated had the same results as those who were most motivated, we need to understand that [obesity] is biological, so responsiveness to weight loss must also be biological,” said Carel le Roux. MD, PhD, professor at the University College, Dublin, in presenting lessons from the SCALE study about predicting weight loss after pharmacotherapy.3
“We tested biomarkers and assessed [responses to] psychological questionnaires, but neither were predictive,” “said Dr. le Roux.
“Since [obesity] medications affect more than one system, the best approach in clinical practice is to identify early responders and continue to treat them, but stop the medication in patients who do not show a favorable response of at least 5% weight loss in 3 months.” This approach should become the standard of care.
Moreover, we don’t have a tradition of removing drugs, rather, we keep prescribing a medication once its been started, said Dr. le Roux. However, responsiveness to medications is evident even after 1 month.3 It behooves physicians to monitor patients and reassess the value of continuing pharmacotherapy between 1-3 months.3
The best practice protocol is to evaluate weight loss at patients who respond desirably with the requisite > 5 % of weight loss in 3 months, and discontinue if this initial level of success has not been met.3,4 This will assure that patients are attaining sufficient benefit versus risks including cost to justify continuation of the medication.
“As we focus on patients who respond well to drug therapy, we must be prepared for more side effects, and seek better quality of life indictors,” said Dr. le Roux. “We don’t have a tradition of removing drugs, rather we just continue to prescribe.”
The best approach to optimal treatment is have “an indication for stopping rule in order to focus on patients who are benefiting, and discontinue treatment for those who aren’t responsive or try another treatment”, according to Dr. le Roux.
1. Holst JJ. The physiology of glucagon-like peptide 1. Physiol Rev. 2007;87(4):1409-39.
2. Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjøth TV, Andreasen AH, Jensen CB, DeFronzo RA, . Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial. JAMA. 2015;314(7):687-699.
3. le Roux C. Predicting weight loss after pharmacotherapy: Lessons for the SCALE study. November 2, 2016. Presented at ObesityWeek, New Orleans, Louisiana.