*Gulp*
Much to the relief of the needle-shy, the FDA has just approved a second oral GLP-1 drug, following the release of the semaglutide Wegovy pill in January.
But this new tablet, from pharma giant Eli Lilly, promises to be even more convenient than its predecessor with similar, if slightly less drastic, weight-trimming results.
According to a press release from Lilly, orforglipron — which is being sold under the brand name Foundayo — punched above its weight in clinical trials. At the highest dose of Foundayo, participants lost an average of 27.3 pounds (12.4% of their body weight) compared to 2.2 pounds (0.9%) with a placebo.
The pill also led to noted reductions in cardiovascular risk factors like waist circumference, non-HDL cholesterol, triglycerides and systolic blood pressure, according to the press release.
In a head-to-head trial assessing its efficacy versus oral semaglutide (Wegovy) in patients with type 2 diabetes, the former outperformed the latter on all key metrics, including overall weight loss and blood sugar control.
These medications are being released on the market at a dizzying speed, as the world’s pharmaceutical leaders race to develop the drug that will produce the most dramatic thinning results — sometimes against advice from doctors.
And while it can be hard to keep it all straight, there are notable differences between the currently available options. Foundayo, for example, is the first GLP-1 that isn’t a peptide, but a synthetic small molecule, which is much stabler than the organic, biological alternative.
Unlike its Wegovy competitor — which comes with strict directions to be taken first thing in the morning with four ounces of water, and 30 minutes before any other medication, food or drink — the Foundayo pill can be taken at any time of day with or without food because of its small molecule composition.
Additionally, NYU Langone obesity medicine specialist Dr. Holly Lofton explains that Wegovy tablets were formulated with an absorption enhancer, which changes the pH of the stomach so the medication can be optimally absorbed.
“Because the Foundayo pill is a small molecule, it does not have that absorption enhancer and that’s what allows the administration to be more variable,” she told The Post.
“This is significant for certain patients who don’t have the most strict morning routine — but also for those who have to take other medications first,” she said, such as thyroid hormones or some osteoporosis meds, which also require morning administration and waiting 30 minutes before consuming anything else.
This pill now opens up GLP-1 access for other patients, too, who may not have been good candidates for injectables or the Wegovy pill, such as those who are overweight but not obese and need to lose slightly less weight, she said.
Whereas injectables lead to an average of 20% weight loss, and the Wegovy pill led to about 16% in studies, the Foundayo pill offers a more modest 12.4%.
And in general, it’s better for patients to have more choices, in case they’re unable to tolerate other GLP-1 drugs.
“We need to have options for those patients,” she says.
Foundayo may also become a go-to medication for long-term weight maintenance, as results from clinical trials found that patients who received Zepbound or Wegovy injections were able to keep most of that weight off when they later switched to Foundayo pills.
In a recent investor conference, Lilly’s chief medical officer David Hyman said that the company’s “mission is to launch this medicine in a volume, unrestricted way throughout the entire world,” which he said was “not possible with injectables, full stop.”
As with other GLP-1s, the list of possible side effects for the Foundayo pill is long. As of now, it comes with warnings of possible thyroid tumors and even cancer, plus pancreatitis, GI issues, dehydration and interference with oral birth control.
Also like other GLP-1s, however, it is less likely to have adverse interactions with heart disease and blood pressure drugs than non-GLP-1 weight loss drugs like Contrave and phentermine.
For her part, as a provider, Lofton feels optimistic about this new approval.
“I’m excited about this medication,” she said. “This is an excellent option that provides flexibility in dosing, and also there were patients I was not able to prescribe Wegovy pills to because of aforementioned issues. So I think this will be a great addition to our toolbox.”
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