Tirzepatide: A Game-Changer Ready for Primetime?

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During the opening press conference, Endocrinology Network got perspective from a trio of American Diabetes Association executives on the prospect of tirzepatide as an agent for combatting both diabetes and obesity.

The term “game-changer” has become synonymous with the American Diabetes Association (ADA) Scientific Sessions. Often considered among the most overused phrases in medicine, the ADA and diabetes community has been able to bear witness to multiple “game-changing” therapies in recent years.

As revelations around the cardiovascular and renal protective benefits of GLP-1 RAs and SLGT2 inhibitors, game-changer was the term assigned to these therapies as the battle against diabetes evolves beyond HbA1c control and towards a holistic management approach seeking to address glucose control as well as risk for adverse outcomes. Now, at ADA 2022, the term game-changer is being tossed out for a new agent—this time, it's Eli Lilly and Company’s dual GIP/GLP-1 RA tirzepatide.

A first-in-class agent that received approval for use as an adjunct therapy to diet and exercise for improving glucose control in patients with type 2 diabetes, tirzepatide has already begun to carve out a niche in clinicians’ armamentarium. With the SURPASS program stealing the show at ADA 2021, new data from the SURMOUNT-1 trial, which examined tirzepatide as a treatment for obesity, is among the most anticipated data releases expected at ADA 2022.

During a press briefing with ADA executives on the morning of June 3, Endocrinology Network used the opportunity to hear their perspective on the therapy and whether the anticipation surrounding its potential as an agent for treating obesity and diabetes. Responses from Dana Dabelea, MD, PhD, chair of ADA 2022, Guillermo Umpierrez, MD, president of medicine and science for the ADA, and Otis Kirskey, PharmD, president of healthcare and education for the ADA, can be found below.

Tirzepatide: A Game-Changer Ready for Primetime?

Endocrinology Network: For the past several years, there has been a therapy or study hailed as “game-changing” presented at the ADA scientific sessions. This year, it seems tirzepatide fits that bill. What is your outlook on the agent as a treatment for diabetes and obesity?

Dana Dabelea, MD, PhD: I think it is a game changer, but remember when metformin was the miracle drug? So, as with any new drug, we have to understand its mechanism of action, who should we target, and whether any miracle drug works or not depends on access. That's also important when we talk about any new drugs that might be less accessible for certain groups of patients. So, I'm very excited. We still need to go through the steps of understanding better how and who to treat with and how to get it to people who need it.

Guillermo Umpierrez, MD: So, let me just make a couple of points. During the last 40 years, we have been having an evolution in how we treat diabetes. From the 80s to the early 2000s, we were only concerned with bringing the hemoglobin A1c down to prevent complications. Then, from 2005 to 2015, we learned that if we push too hard people get hypoglycemia and we can hurt patients.

Now, we have a new area of cardiovascular protective drugs, kidney protective drugs that have been shown to decrease mortality and be very effective not only in bringing the blood glucose down, but preventing heart attack, cardiovascular death, and chronic kidney disease. So far, no one had been working on obesity drugs. Less than 5% of patients with diabetes who are obese experience any kind of significant weight loss because medications do not provide this. Until very, very recently, they were just related to bringing HbA1c down to prevent cardiovascular disease. Now, we have learned from the GLP-1 RA story that high doses, and there are now there are several on the market, once a week can produce significant weight loss. This is with GLP-1 RA.

This new drug is a GIP/GLP-1 receptor agonist—two very similar compounds that result in improvement of glycemic control and significant weight loss. I mean, similar to the degree of weight loss seen with bariatric surgery. So, we are now at a point where we are going to maybe shift how we see the future of diabetes care, but it has been an evolution and it has been an evolution for 30-40 years. Now, I think we're on a new frontier for years to come.

Otis Kirskey, PharmD: As a diabetes educator and manager in a federally qualified community health center with a patient population consisting primarily of African American and Latino patients, we see patients could benefit tremendously from a drug such as that. However, the access issue is what really concerns me and whether or not we'll be able to get this particular, very important game-changing drug to those patients who desperately need it. There are marginalized communities that can't afford, or they are uninsured or underinsured. So, in terms of this game-changer, I think that the rate-limiting piece, as far as I'm concerned, is going to be the access.

This transcript has been edited for clarity and length.