Eli Lilly’s Maunjaro: A Revolutionary Treatment for Type 2 Diabetes with Potential Weight Loss Benefits
The Surprising Findings of Clinical Trials
Maunjaro, a drug developed by Eli Lilly, has garnered significant attention for its potential to induce weight loss. The results of a clinical study conducted a year ago, which were published in the New England Journal of Medicine, revealed an average weight loss of 15-20.9%. While Maunjaro is currently only approved as a diabetes treatment in Korea, its remarkable weight loss effects have been widely acknowledged.
Despite the successful weight loss outcomes, concerns over the drug’s safety have emerged. Particularly, questions have been raised about its suitability for Asian populations, who generally have smaller physiques compared to Westerners. To address these concerns, Robert Heine, Vice President of Eli Lilly’s Medical Division, recently shared the results of post-mortem analysis from six Surpass clinical trials in East Asian patients with type 2 diabetes (Japan, Korea, Taiwan). The analysis revealed that even in patients with a body mass index (BMI) of 25 kg/m2 or less and those over 65 years of age, there were reports of hypoglycemia and hypotension, similar to other patient groups. Heine emphasized that most patients maintained a healthy BMI and did not fall into the underweight range.
The Role of the GIP Hormone: A Metabolic Switch
Maunjaro works by selectively binding to the insulin secretion-stimulating peptide (GIP) receptor and the glucagon-like peptide-1 (GLP-1) receptor. Unlike competing drugs like Ozempic and Wigobi, which primarily act on GLP-1 receptors, Maunjaro specifically targets GIP receptors. The GIP hormone plays a crucial role in regulating metabolism. It aids in the absorption of fat into adipose tissue after a meal and facilitates fatty acid secretion from adipose tissue during fasting, ensuring a constant energy supply for the body. It also promotes the secretion of glucagon to stabilize blood sugar levels when they drop.
Heine highlighted that in the Surpass clinical study, nearly half of the patients administered a 15 mg dose of Maunjaro achieved normal levels of glycated hemoglobin (HbA1c <= 5.7%), thanks to the action of the GIP hormone. He further noted that Maunjaro also demonstrated positive effects on reducing blood pressure and fat, including neutral fat, which were comparable to current GLP-1 agents used in diabetes management.
Concerns about patients falling into the underweight range were addressed by Heine, who explained that the clinical study involved random allocation, leading to underweight patients receiving higher doses. He reassured that in actual clinical practice, the appropriate dose would be determined based on factors such as age and BMI to prevent patients from becoming underweight.
The Significance of Weight Loss in Type 2 Diabetes Management
While weight loss may be seen as a cosmetic goal, it holds immense importance in managing type 2 diabetes. Studies have shown that weight loss alone can help patients with this condition maintain a non-diabetic state without the need for medications. Recognizing this, Eli Lilly aims to go beyond typical diabetes treatment by targeting early-stage diabetes patients, lowering their blood sugar levels, lipids, and blood pressure to normal ranges, ultimately improving outcomes. The company is also conducting clinical research to evaluate the long-term effects of maintaining these parameters.
Notably, weight loss is emphasized in the guidelines for type 2 diabetes by reputable organizations such as the American Diabetes Association (ADA) and the European Association for Diabetes Mellitus (EASD). However, Vice President Heine cautioned against focusing solely on weight loss results, as social media tends to highlight this aspect without considering other crucial factors.
A Paradigm Shift in Type 2 Diabetes Treatment
Heine believes that the current sequential treatment approach to managing type 2 diabetes is flawed, leading to suboptimal outcomes. Despite the introduction of numerous new drugs over the past decade, the average glycated hemoglobin levels in the United States have continued to rise. He attributes this phenomenon to the sequential administration of treatments, which he claims is a failed strategy. Heine advocates for a new paradigm in diabetes treatment globally, urging a shift away from repeat failures seen in managing diseases such as rheumatoid arthritis, high blood pressure, and cancer.
However, he acknowledged the importance of basing medical practice on scientific evidence and recommended against utilizing new drugs without solid research and evidence. He stressed the need for a comprehensive assessment of diabetes treatment to establish a foundation for a change in the current approach.
The Future of Maunjaro and Its Global Launch
As for the launch of Maunjaro in Korea, no specific plans have been announced. Vice President Heine mentioned the high demand for the drug and expressed concerns about ensuring a stable supply once it is launched. Eli Lilly has recently opened a new factory in North Carolina with the aim of doubling Maunjaro’s production capacity. However, the company is taking a cautious approach in determining the timing of the global launch, considering the increase in production volume and the needs of patients who have already started using the medication.
Heine concluded by emphasizing his commitment to developing Maunjaro as an obesity treatment, with a particular focus on reducing morbidity and mortality in obese adults. He believes that a careful and deliberate approach is crucial to maximize the drug’s impact in the field of diabetes management.
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Most people do not collapse under weight … GIP hormone ‘metabolic switch’
Approved as a treatment for type 2 diabetes only, what does it mean for weight loss?
Lilly Medical Division Vice President “Sequential Type 2 Diabetes Treatment = Defeat”
Robert Heine, Vice President of Eli Lilly Medical Division ⓒNewspaper of the Korea Medical Association
Eli Lilly’s Maunjaro (ingredient name: terzepatide), which attracted attention after the clinical results of ‘20% weight loss’ were revealed, is attracting attention as low blood sugar levels and low blood pressure are similar to’ those in other patient groups have been reported even in elderly and low BMI patients.
The results of the Maunjaro clinical study were released a year ago. [NEJM]It became famous when it was published in . Research results showed an average weight loss of 15-20.9%. It is currently only approved as a diabetes treatment in Korea. However, it was first known to the public for its incredible weight loss effects.
As the surprise effect was achieved, attention also focused on safety issues. In particular, there was an interest in whether it would be okay in Asia, such as Korea, where people are smaller than Westerners.
Robert Heine, Eli Lilly’s Vice President of Medicine, recently stated in an exclusive interview with this magazine that patients from East Asia with type 2 diabetes (Japan, Korea, Taiwan) who received 5, 10, and 15 mg of Maunjaro once a week in six SURPASS clinical trials The results of the post-mortem analysis were reported.
In the analysis, even in the group with a BMI of 25 kg / m2 or less and over 65 years of age, hypoglycemia and hypotension similar to those of other patient groups were reported when the highest dose of Maunjaro was given.
Vice President Robert Heine emphasized, “It is also important that the BMI of most patients did not fall below the underweight standard (<18.5kg/㎡)."
This means that even in patients with a low BMI, physiological values such as blood sugar, blood pressure, and lipids dropped to a certain level and then did not drop further.
This is because GIP hormone acts as a ‘switch’ in metabolism.
Maunjaro binds selectively to the ‘insulin secretion-stimulating peptide (GIP) receptor’ and the ‘glucagon-like peptide-1 (GLP-1) receptor.’ The difference between Ozempic and Wigobi (ingredient name: semaglutide), which are mentioned as competing drugs, is that it acts on GIP receptors.
The role of GIP in the body varies greatly depending on the situation.
When fat is consumed through a meal, it helps the fat to be absorbed into adipose tissue. Conversely, when a state is close to fasting, fatty acids are secreted from adipose tissue, metabolized, and play a role in maintaining the body’s energy even on an empty stomach. When blood sugar levels drop, GIP promotes the secretion of glucagon to keep blood sugar levels constant.
Vice President Robert Heine said, “In the SURPASS clinical study, about half of the group administered 15 mg of Maunzaro reached a normal level of glycated hemoglobin (HbA1c <= 5.7%). This was thanks to GIP," adding, "The result in a reduction in blood pressure and fat, including neutral fat. "We also confirmed that the tolerance is similar to that used by the current GLP-1 agent," he explained.
However, it was added that BMI fell into the underweight range in a small number of patients. The explanation is that if an appropriate dose is used rather than a high dose, the BMI will not drop into the underweight range.
Vice President Robert said, “Because the clinical study was conducted by random allocation, underweight patients received high doses,” and added, “In actual clinical settings, the appropriate dose is administered by consider the patient’s age and BMI.”
Approved as a treatment for type 2 diabetes only… What does weight loss mean?
Robert Heine, Vice President of Eli Lilly Medical Division ⓒNewspaper of the Korea Medical Association
When a reporter took a personal interest in the explanation that it was effective even for patients with a low BMI, the vice president seemed to draw a line, saying, “It is not wise to use it for cosmetic purposes.” However, it is also true that ‘weight loss’ is an important indicator in managing diabetes.
In fact, according to a British study, it has been proven that patients with type 2 diabetes can maintain a non-diabetic state just by losing weight without taking drugs.
Vice President Robert said, “Weight loss plays a very important role in managing type 2 diabetes,” and added, “We’re going one step further and targeting patients with early diabetes by lowering blood sugar levels, lipids, and blood pressure to normal levels and improve outcomes.” “Clinical research focusing on the effects of maintaining the condition is also underway,” he said.
Obesity is a systemic disease, affecting multiple organs. As this aspect has become more important recently, weight loss is recommended in the guidelines for type 2 diabetes of the American Diabetes Association (ADA) and the European Association for Diabetes Mellitus (EASD).
Vice President Robert said, “Right now, stories that focus only on weight loss results are being spread through social media. I don’t think this is desirable,” and added, “Maunjaro’s research on obesity treatment is also underway with a focus on this point ■ A representative study “The SURMOUNT-MMO phase 3 study, the Maunjaro study is on reducing morbidity and mortality in obese adults,” he explained.
“Sequential treatment for type 2 diabetes is bound to fail.”
“Over the past 10 years, a number of new drugs for the treatment of type 2 diabetes have been released. However, the average glycated hemoglobin in the United States has actually increased… This is believed to be due to the sequential administration of the treatment for the second, third, and fourth doses. The sequential administration failed. “It’s a pattern that he has no choice but to do.”
The opinion is that it is time to have a new method of managing type 2 diabetes patients. He also emphasized that this is something he wants to demand from all over the world, not just Korea.
In response to a question about whether it is recommended to use a newly released drug from scratch, he took a cautious stance, saying, “All medical practice should be based on science and evidence. Even if the hypothesis makes sense , we can’t do that. make a recommendation again.”
However, “I would like to emphasize once again that we need to think about a new paradigm of diabetes treatment,” he said. “No matter what disease you look at, including rheumatoid arthritis, high blood pressure, and cancer, there’s no reason it follows repeated failures like diabetes.” “This is also part of an effort to establish a basis for changing the treatment pattern.”
As for the launch schedule in Korea, he said no specific plans have been made, saying, “After a stable delivery environment is created.”
Vice President Robert said, “Currently, demand for Maunjaro is high and showing a steep upward trend. This is good news, but there are also concerns about supply. Once launched, it cannot stop supply for patients who have started taking the medication, so we are concerned about the timing of the launch in each country. “We are taking a very cautious approach,” he said. “We recently opened a new factory in northern North Carolina. We will take steps to more than double Maunjaro’s production volume within However, the timing of the global launch is cautious, regardless of the increase in production.” “We intend to make a decision based on this,” he said.
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