“For those dealing with obesity, especially severe obesity”, the advent of new drugs for the treatment of this complex pathology “has been seen as the first real turning point in the last 30 years”. Simona Bertoli, full professor of clinical nutrition and director of the School of Specialization in Food Science at the State University of Milan, made the point to Adnkronos Salute. In the framework already characterized by the presence of liraglutide and semaglutide, a new molecule of this therapeutic class arrives in Italy, tirzepatidewhich acts on both Gip and Glp-1 receptors.
“The previous turning point was bariatric surgery” in its less invasive development. Then there was a further advancement, which was that of the so-called Very low-calorie ketogenic diet (Vlckd), which for a long time were very little paid attention from a scientific point of view and instead in recent years there have been several studies supporting their effectiveness even in the most serious forms, and they are currently widely used”. But “a pharmacological approach was not there. Now, between diet and bariatric surgery, we have many options. And new drugs are also expected in the coming years, which are being tested and are in phase 1 or 2. We’re talking about at least another dozen therapies,” he says.
Tirzepatide “expands the pharmacological armamentarium that we currently have available for obesity”, highlights the expert who directs the Obesity Centers and the Nutrition and Obesity Research Laboratory at the Irccs Auxologico in Milan. “Pharmacological treatment is a very hot topic at the moment, and it was included in the guidelines several years ago. Then obviously the drugs arrived at different times in the various countries, Italy was among the last. But now our approach to the pathology is changing for the better, because at this point in patients who have not responded to what remains the first level of therapy, i.e. lifestyle intervention, we have a second step AND in the people actually treated we have had excellent results from the point of view of weight loss and also of correcting the risk factors and complications of obesity.”
“At this moment the problem of costs remains very strong – explains Bertoli – Because the drugs require a compulsory medical prescriptionbut completely at the expense of the patient, unless he also has diabetes” and then they are reimbursed. “This happens because obesity was also recognized in Italy in 2019 as a pathology, and has therefore entered the list of chronic pathologies, however neither the specific exemption codes nor the LEAs have been defined. Added to this is the problem that the pathology particularly affects the lower social groups. At the moment we are in the order of 350 euros per month” for a long-term therapy.
“At the beginning – analyzes Bertoli – the patients experienced the idea of relying on the drug as a bit of a defeat on the diet therapy which they were unable to carry out, and they had a certain distrust because they had been using drugs for years that were never specific for the obesity, often prescribed off label, which in some cases had important side effects, and partly also for a question of communication, because it was said that the path to follow was not the pharmacological one but learning to eat, improving activity physical, lifestyle. To date, however, in light of what has been heard about the safety of these drugs and the latest data released on semaglutide which show a reduction in mortality from cardiovascular disease, the attitude of the patient with obesity towards the therapy significantly improved“.
In practice, “we offer the treatment to many patients, but – observes the expert – the number of those who accept is lower, essentially due to the question of costs. In the context of freelance activity I note a higher figure, in the context of the national health system the numbers are reduced. We have just done a study in which, in fact, we started with dietary therapy alone and those who did not respond were offered pharmacological treatment and of these only 27% accepted, despite the failure on the diet. Going to investigate the causes, it emerged that the main reason in 60% of cases was economic.”
So this brake remains. Also because the duration of therapy is not short. “The studies that have come out show that treatment followed up to 4 years later determines an initial significant weight loss and then maintenance of the lost weight. However, they also show that those who suspend it in these randomized placebo studies have a risk of weight recovery. It will be a matter of seeing what happens in real life. It is possible that weight loss leads people to make a different investment in themselves and to change the level of physical activity and other elements that could also cause them not to. everyone recovers the lost weight. But at the moment we don’t have this data”, reasons Bertoli. As for the new entry tirzepatide, “promises even greater results, because weight loss can be achieved in approximately 30% of patients, even around 30 kgwhich is something similar to what you get in bariatric surgery. And it can be said that practically 98% of patients lose at least 5% of their weight, which is the first objective of a dietary intervention.”
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