Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
If you were thinking about starting your weight loss journey or maybe you’ve been on Zepbound and Wegovy or either of those two for any period of time, you might’ve heard about the new higher dose of Wegovy called Wegovy HD. HD stands for high dose Wegovy. This is a 7.2 milligram dose of medication and you might be like, “Huh, is that a good choice of medication for me? ” Today we are going to talk about that.

Welcome to the Conquer Your Weight Podcast where we dive into the evidence-based medicine and the psychological support that you need to support you in your weight loss journey. I am so excited to have you here. I’m also on YouTube. So if you’re watching on YouTube, I would so appreciate you liking and subscribing. I’ve been trying to grow things over there. So if you’re on the audio-only version, come find me on YouTube. I would love to have your support over there as well. Thank you for being the listener of my podcast. And one of the things that has been really exciting, but honestly, it’s been a little hard to keep track of recently is we have had a lot of changes in the medication space for all of the different GLPs that are available. So when we think about medications that are available for weight loss, everyone’s mind automatically jumps to the GLP medications. And that’s great. That’s what we’re going to talk about today. There are other ones, non- GLP medications that are available as well and may be really good fits for the right person, but the GLPs have been very popular for a reason. So today we are talking about that Wegovy HD dose. So let’s take a step back and talk about Wegovy in general. You’ve probably heard the name Wegovy thrown out.

It is a semaglutide medication that is FDA approved for the treatment of overweight and obesity. It has also a secondary approval for two different conditions for cardiovascular risk reduction for patients who have a history of preexisting cardiovascular disease like heart attack or stroke. More recently, it has had a indication for liver disease for people who have metabolic associated liver disease. Previously, this was called fatty liver or non-alcoholic fatty liver disease. And so it has that indication as well. The Wegovy medication is a semaglutide product. The OG medication here was Ozempic. So Ozempic is also semaglutide. Ozempic is FDA approved for the treatment of type two diabetes. Now, Ozempic and Wegovy are the exact same medication. There is some overlap in the dosing, but there have been some differences. So Ozempic is available in 0.25, 0.5 milligrams, one milligram, and two milligrams. Previously, it was just available in three doses, but over the last couple of years now, we’ve seen it available up to that two milligram dose, at least if you’re in the States, that’s not the case necessarily worldwide.

And then the Wegovy dosing actually has previously gone up to 2.4. So the dosing regimen looked a little bit different. It was 0.25 milligrams, 0.5 milligrams, 1.0 milligrams. So the same for those first three doses. Then there was a 1.7 milligram dose and a 2.4 milligram dose. Now, the Wegovy medication has only ever been available in single dose pens. And so for good or for bad, there’s some ease with injection of a single dose pen, and that has been available now for the last couple of years. And it has just been in the last two weeks now that we’ve seen the approval and the availability of the Wegovy HD medication. So the HD is a 7.2 milligram dose. So that is three times higher than the previous higher dose, which was the 2.4 milligram dose. Now let’s talk about, is it actually worthwhile to take that?

Who is the right fit for that medication? Who should we be thinking about this for? Is this the new best medication on the market or how does it compare to Zepbound? Let’s dive into some of that data. So in this trial, there was a trial. When we look at the clinical trials for medication, we have phase three trials, which are the phase before medications are FDA approved. Then there can be additional trials when they’re looking for additional indication or additional dosing, for example. So this is a phase 3b clinical trial where they took patients and titrated them up all the way to the 7.2 milligram dose. So patients in this trial were patients who had a BMI of 30 or higher or patients who had a BMI of 27 or higher with a weight-related comorbidity. So that’s things like high blood pressure, high cholesterol, any sort of fatty liver, maybe arthritis, many health conditions that can be associated with weight.

So if you have any comorbid condition with a BMI of 27 or higher or just a BMI of 30 or higher, those were the patients that were enrolled in this clinical trial. They were escalated up. So every month they started on the lowest dose of the medication. Then every four weeks they brought them to the next dose of medication and then titrated them every four weeks to that top dose of medication, the 7.2 milligram dose of medication. And then compared that to the 2.4 milligram dose of medication, the previous highest dose of medication versus placebo. And what they saw was that on average, patients who came all the way up to that top dose of medication lost 18 to 21% of their body weight depending on which calculations we use here. And so this is where sometimes we get into the different analytics of how are we assessing these numbers and what is the data that we are using?

So in clinical trials, there are patients who are randomized to receive one to receive the medication, maybe to receive placebo. And then people drop out of trials for a wide variety of reasons. Sometimes people drop out because maybe they are having severe side effects. And so they’re like, ” You know what? Forget it. I don’t want to take this medication. “Maybe it’s pretty obvious that they’re in the placebo arm of the medication or of the trial rather. And they’re like, ” You know what? I don’t want to be taking the placebo. I want to be taking a medication that’s actually having effect for me. And so I’m just going to drop out of this trial and then I’ll do something else, whether it’s paying for Ragovi out of pocket or using any other sort of medication or program. For example, patients who are enrolled in this clinical trial cannot obviously be on other medications for weight loss.

They can’t be engaged in other intensive lifestyle modification programs for weight. So patients may get frustrated, especially if they’ve been randomized to the placebo arm. They don’t know. It’s blinded, but certainly the effect of these GLP medications can be pretty potent. So a lot of times patients have a pretty good clue if they’re in a placebo arm of a trial, and so they may decide to drop out for that reason so that they could do something else to support their weight journey. They’re like, “You know what? I don’t want to be in this trial for the next 72 weeks.”

I’ve shared before, I’m actually in a clinical trial right now as a study participant for menstrual migraine medications. And I will say it’s been a really fascinating process to be a participant in a clinical trial, but it’s a really significant time commitment. So I go in once per month and I’m there for usually about three, maybe slightly over three hours when I’m there. And so even just the logistics of going to the clinical trial, does that align with your work schedule? Is it convenient for you to stay in that? All sorts of reasons that people drop out of clinical trials. Now for the people who stayed in the clinical trial, and if we do the math based on who are the people that started on the medication, and if all patients were to stay on the medication, the average weight loss for someone taking that 7.2 milligram dose over the 72-week study period was 20.7%. If they use the treatment regimen Esteman, which is the people who were analyzed, regardless of whether they stayed in the trial, whether they dropped out, everyone’s analyzed even if people dropped out of the trial, the efficacy was a little bit less, obviously, 18.8%. So we’re talking about really about 20% total body weight loss compared to patients who were taking placebo.

Now, if we look at that compared to the 2.4 milligram dose that previously higher dose of medication, that’s closer to about 15%, 15%, 16%, depending on which meth that we use there of patients who were having the amount of total body weight loss that they had over that 72 weeks. Now, when we look at the side effects, this is a big question that comes up, and the side effects were higher. So particularly those gastrointestinal side effects, nausea, vomiting, diarrhea, constipation, the ones that people tend to have on the GLP medications in general, they did notice that some of those were worse on this medication. So on average, about 61% of patients who were taking the 2.4 milligram dose of medication had GI side effects. On the 7.2 milligram dose of medication, it was almost 71% of patients. So about 10% more patients had those GI side effects.

Now, those side effects do decrease over time. Many people are able to manage those, but if you are someone who’s already having significant side effects, for example, on a lower dose of medication, you’re someone that we’d want to be really careful before moving to that higher dose of medication. We’d want to make sure that your side effects are either gone or that they’re really well managed. Let’s say you have constipation, for example, we’d want to make sure that your constipation is really well controlled. Maybe you have a good bowel regimen with Metamucil or MiraLax or something like that to keep you in a good routine before we would want to escalate to the next dose. And honestly, that’s true for any of these medications across any of the doses. As we’re thinking about increasing the dose, we want to make sure that your side effects are well managed before we’re increasing to that next dose of medication.

So when someone though is on Wegovy, let’s say they’ve liked the Wegovy, it’s been working really well for them. They’ve been on the 2.4 milligram dose for a while and they have additional weight to lose, moving up to that 7.2 milligram dose may be the perfect move for them. So it’s absolutely going to be an option. I think one of the biggest questions that people have had is, well, how does this compare to Zepbound? Because isn’t that a pretty good medication? Aren’t those numbers pretty similar? Now, I will say that officially there are no head-to-head trials of the Wegovy 7.2 milligram dose versus the Zepbound doses of medication. Previously, or I guess even currently we have the SURMOUNT-5 trial, which was a trial looking at the Zepbound at 10 milligram or 15 milligram, the maximum tolerated dose of medication versus the Wegovy 1.7 or 2.4 maximum tolerated dose of medication.

What were the average weight differences for those over the 72-week trial period? And for patients in that study, the Zepbound medication was more potent, but as we now look at this higher dose of Wegovy, how will the potencies of those two different medications compare? So again, we don’t have the official data, but we have data from all the Zepbound trials, the SURMOUNT trials. We have data from the STEP UP trial, this new Wegovy 7.2 milligram trial, and honestly, it looks like they’re going to be pretty similar. So when you look at the Zepbound 10 milligram dose, on average, patients taking the Zepbound to 10 milligram lost 19.5% of their body weight or 21.4% of their body weight, depending on which calculation they used, then patients taking the Zepbound 15 milligram dose lost an average of 20.9% total body weight versus 22.5% total body weight, depending again on which calculations that we use there.

So really talking about two medications, whether we’re talking about the Zepbound at the 10 or 15 milligram dose, whether we’re talking about the Wegovy at the 7.2 dose, really we’re talking about two medications that are approaching 20% total body weight loss or maybe slightly more. So overall, I’m not super excited about the Wegovy HD option. The Zepbound medication has been a more potent option and looks like it is still a slightly more potent option compared to the Wegovy HD dosing. Now in Surmount five, that Zepbound versus Wegovy trial, again, the Wegovy was at lower doses. They looked at the side effect profiles and overall those medications were pretty similar in terms of side effects with setbound being slightly less side effects compared to the Wegovy. In my clinical practice, one of the things I see most significantly between the two medications is that the semaglutide products, so Ozempic and Wegovy tend to create more constipation compared to the tirzepatide products like Zepbound and Mounjaro.

Those can create constipation, and I do have patients who have constipation on those medications, but they may be less likely to create some of that severe constipation. Some patients have diarrhea, can occur on both the medications, but seems like diarrhea is a little bit more common on Zepbound or Mounjaro medications. But the overall in that SURMOUNT-5 trial of Zepbound versus Wegovy, the Zepbound had slightly less side effects. So certainly as we think about a higher dose of Wegovy that had more side effects than the 2.4 milligram dose, we are thinking about, hey, this is likely going to create more side effects. But again, the patient who’s on Wegovy, they’re doing well on it. Maybe they’ve come up to the 2.4 and it’s been working well, but patients, they’ve plateaued, their side effects are well managed. That 7.2 dose is going to be a really decent option for them.

Now, if you have insurance coverage for the Wegovy medication, you can anticipate coverage. Also for that higher dose at 7.2. If you’re paying cash out of pocket, they do have a cash pay price. All the lower Wegovy doses are $349 per month. That higher Wegovy HD is $399 per month through the NovoCare pharmacy, and it should be available soon in retail pharmacies as well. So bring it up.

If you are on a weight loss journey, thinking about the different medications that are available to you, especially as things are navigating this, things are changing all the time. Make sure that you’re having those conversations with your physician. Ask them about what are the best options for me? Is there another dose of medication? Should I be thinking about something else? It’s important that you’re asking those questions and understanding, am I on the best choice of medication for what my needs are? If you are looking for someone to support you in your weight wash journey, I would love to help you. I see patients in person in Charlottesville, Virginia and throughout the states of Illinois, Tennessee, and Virginia for telemedicine. You can learn more at www.serasdambamd.com. Thanks for joining us today. We’ll see you all next week.