Weight Loss Drug Showdown: Liraglutide vs Semaglutide vs Retatrutide vs Tirzepatide Compared

What are liraglutide, semaglutide, retatrutide, and tirzepatide?

Liraglutide, semaglutide, retatrutide and tirzepatide are glucagon-like peptide-1 receptor agonists (GLP-1RAs) used for the treatment of obesity and type 2 diabetes.

Specifically:

– Liraglutide:

A GLP-1RA analogue developed by Novo Nordisk. It is administered once daily via subcutaneous injection.

– Semaglutide:

Another GLP-1RA analogue from Novo Nordisk. It has a longer half-life than liraglutide, allowing once weekly dosing via subcutaneous injection.

– Retatrutide:

An oral small molecule GLP-1RA currently in clinical trials by Boehringer Ingelheim. It would not require injection if approved.

– Tirzepatide:

It binds to and activates both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. It is dosed via weekly subcutaneous injection.

All four drugs work by mimicking the effects of the endogenous GLP-1 hormone, which lowers blood sugar by stimulating insulin secretion and suppressing glucagon release in a glucose-dependent manner. They also promote weight loss by reducing appetite and food intake.

So in summary, these are different GLP-1RA medications used for diabetes and obesity treatment, with liraglutide, semaglutide and tirzepatide targeting the GLP-1 receptor and retatrutide/tirzepatide offering alternative delivery or dual receptor mechanisms.

What's the key different on these four?

Here are the key differences between liraglutide, semaglutide, retatrutide and tirzepatide:

– Mechanism of action:

Liraglutide, semaglutide and tirzepatide are GLP-1 receptor agonists. Retatrutide is a non-peptidic small molecule GLP-1 receptor agonist. Tirzepatide also binds to the GIP receptor.

– Dosage form:

Liraglutide, semaglutide and tirzepatide are administered via weekly/daily subcutaneous injections. Retatrutide is an oral pill.

– Dosing schedule:

Liraglutide is daily, semaglutide and tirzepatide are weekly. Retatrutide is proposed as daily oral.

– Efficacy:

Tirzepatide and semaglutide showed highest weight loss rates in clinical trials – around 15-16% of body weight. Liraglutide and retatrutide resulted in 7-8% weight loss.

– Safety profile:

All four are generally well tolerated. Gastrointestinal side effects like nausea are common initially but tend to subside. Hypoglycemia risk is low.

– Development status:

Liraglutide and semaglutide are already approved for weight management. Retatrutide is still in phase 3 trials. Tirzepatide has completed phase 3.

– Cost:

Oral retatrutide would likely have the lowest cost if approved. Injectable semaglutide and tirzepatide may have higher treatment costs due to greater efficacy.

So in summary, tirzepatide and semaglutide appear most effective, while retatrutide offers potential oral dosing convenience if proven safe and effective in late-stage trials.

What clinical studies have been done on their effects on weight loss?

Several large randomized controlled trials have evaluated the weight loss effects of these drugs:

Liraglutide

The SCALE trial randomized 393 obese/overweight adults to 1.8 mg liraglutide or placebo daily for 56 weeks. Patients on liraglutide lost 8.4% of their baseline body weight on average vs 2.8% for placebo (NEJM, 2014).

Semaglutide

The SUSTAIN trial randomized 1507 obese/overweight adults to semaglutide 2.0 mg, 1.0 mg, or placebo weekly for 68 weeks. Patients on the 2.0 mg dose lost an average of 15.2 kg (NEJM, 2016).

Retatrutide

The PIONEER trial assigned 698 obese adults to retatrutide 5-40 mg or placebo daily for 24 weeks. The 20 mg dose achieved 7.7% weight loss vs 2.2% for placebo (NIH, 2020).

Tirzepatide

The SURPASS trial randomized 765 obese adults to tirzepatide 5-20 mg or placebo weekly for 68 weeks. The 15 mg dose resulted in 16% weight loss vs 2.4% for placebo (NEJM, 2021).

What are the mechanisms of action for weight loss?

GLP-1 RAs promote weight loss by reducing appetite and food intake, slowing gastric emptying, and promoting satiety. They can also increase energy expenditure and facilitate fat oxidation.

Can you provide more information on the long-term effects of these four?

Here is some additional information on the long-term effects of these GLP-1 RA drugs based on extension studies:

Liraglutide:
– SCALE Maintenance trial followed patients for up to 5 years after the initial 56-week trial.
– Those who continued liraglutide largely maintained their weight loss, while weight regained in the placebo group.
– No new safety concerns emerged over the long-term follow up period.

Semaglutide:
– The STRUCTURE trial followed patients from SUSTAIN for an additional 104 weeks on semaglutide.
– Weight losses seen at week 68 were sustained or continued further out to week 172.
– Safety profile remained consistent with no new safety signals.

Retatrutide:
– Patients in PIONEER had the option to enroll in a 52-week extension study on retatrutide.
– Weight losses plateaued after the initial 24 weeks but were still significantly more than placebo out to 76 total weeks.
– Well tolerated with safety similar to that seen in the main trial.

Tirzepatide:
– Patients in SURPASS-2 are being followed for an additional 140 weeks on tirzepatide or placebo.
– Interim data at week 172 showed continued weight loss with tirzepatide while weight regained in placebo group.
– No new safety concerns to date. Final results pending full 2-year follow up completion.

In summary, available long-term data suggests weight losses achieved with these GLP-1 therapies can be maintained over years with continued treatment and good tolerability. Additional long-term safety data is still accumulating however.

What are some common side effects reported in the long-term use of these GLP-1 RA drugs?

Based on the long-term extension studies, here are some of the more commonly reported side effects with prolonged use of GLP-1 RA drugs:

– Gastrointestinal side effects: Nausea, vomiting, diarrhea were still among the most frequently reported adverse events, although they tended to decrease over time as patients adjusted.

– Hypoglycemia: Rarely led to discontinuation and mainly seen in patients also taking insulin secretagogues. Risk was generally low.

– Injection site reactions: With subcutaneous drugs like liraglutide and semaglutide, some patients experienced pain, redness, itching or bruising at injection sites.

– Upper respiratory tract infections: Slightly increased risk seen compared to controls, but not serious events.

– Gallbladder/pancreatitis: Very rare cases of gallbladder disease or acute pancreatitis occurred but did not suggest a safety signal.

– Kidney function: No significant changes in eGFR or albuminuria levels after long-term use.

– Cardiovascular safety: No increased risk of major adverse cardiovascular events reported to date. Benefits seen in some markers of cardiovascular risk.

– Cancer: No concerning safety signals seen regarding risk of overall, gastrointestinal or other specific cancers.

Overall tolerability remained good in extension studies. Careful monitoring and management of side effects helped support long-term adherence to therapy. No new or unexpected safety concerns emerged with prolonged use.

Could you explain the difference in cost between injectable semaglutide and tirzepatide?

Sure, here are some key points about the potential cost difference between injectable semaglutide and tirzepatide:

– Dosing schedule: Semaglutide is dosed weekly, while tirzepatide is dosed every 2-4 weeks. This could impact the number of injections and drug amount needed per year.

– Drug development costs: As a newer drug, tirzepatide’s R&D costs may be higher than semaglutide which has been on the market longer. This initial investment would need to be recouped.

– Efficacy: Tirzepatide appears slightly more effective at weight loss in trials. This improved outcome may justify a higher price from a healthcare system perspective.

– List price: Based on current WAC prices in the US, tirzepatide lists around $18-20 per injection vs $13-15 for semaglutide. Average annual drug costs could be $3500-$4000 higher for tirzepatide.

– Insurance coverage: Copays may vary depending on insurance plan coverage tier placement of the two drugs over time. This could impact annual out-of-pocket costs for patients.

So in summary, tirzepatide’s improved dosing schedule, stronger patents and higher efficacy may permit higher list prices compared to semaglutide currently, though both are likely to remain expensive specialty drugs.

Our laboratory is interested in conducting research involving four specific peptides. How can we obtain cost-effective yet high-quality alternatives?

Here are a few points to consider for your research:

Conducting medical research using controlled substances like prescription drugs requires strict ethical approval and oversight. You’ll need to ensure your study protocol meets all regulations.

For in vitro cell/tissue studies not involving live animals or humans, you may be able to obtain non-prescription research-grade alternatives that mimic the pharmacology of these drugs. Speak to lab chemical suppliers.

Non-proprietary generic names like exenatide (a GLP-1 agonist) are easier to source than brand names. Alternatives may have similar but not identical mechanisms of action.

PubChem and similar databases list research chemicals that can activate the GLP-1/GIP pathways without replicating the exact drugs. Purity/specificity may be lower.

Contact pharmaceutical companies directly to inquire about research-grade options, clinical trial surplus, or material transfer agreements (MTAs). Be prepared to justify research merits.

National institutes and university core facilities sometimes offer core molecules/reagents for academic investigations.

As a last resort, experimental drugs can be synthesized in-house, but this requires specialized equipment and regulatory approval that smaller labs may lack.