Interest in weight loss medications has been revived with the introduction of the highly-effective GLP-1 drugs. Demand for Novo Nordisk's Wegovy is so high that the manufacturer has been unable to maintain supplies and "bootleg" compounded semaglutide has become a thing. Lilly's Mounjaro, which is currently only approved for diabetes, is more effective than Wegovy and will likely see even higher demand.

So how do the new drugs compare with the old? Which patients qualify, and what are their options if they don't? We break it down for you at the link below.

• Weight loss drug review

An open-label study (N=26,411) published in The Lancet compared molnupiravir to usual care in patients with confirmed COVID-19 for 5 days or less who were older than 50 or older than 18 with relevant comorbidities (mean age 57 years); 94% of the participants had received 3 or more doses of a COVID vaccine. At the end of the study, there was no difference between the two groups for the primary outcome of all-cause hospitalization or death within 28 days (1% vs 1%).

Molnupiravir has mainly been used as a second-line agent behind Paxlovid because it was less effective in early trials, where both drugs were studied in unvaccinated patients. In The Lancet study, only 3 patients in the molnupiravir group and 5 in the usual care group died, showing how vaccination has greatly improved COVID outcomes. It's hard to imagine that Paxlovid would perform any better, which suggests neither drug may be necessary in most vaccinated patients.

• Molnupiravir vs Usual Care for COVID-19 in a Highly Vaccinated Population [PubMed abstract]
• COVID management

On February 24th, the DEA proposed new telemedicine regulations for controlled substances (CS). To provide some background, a federal law has been in place since 2008 that prohibits telemedicine providers from prescribing controlled substances to patients they have never seen in person. That law has been waived over the last 3 years due to the COVID public health emergency (PHE), which is ending May 11th. Highlights from the proposed rule changes include the following:

• NOTE: For DEA purposes, the term "narcotic" refers to opioids and their derivatives.
• Current telemedicine patients: providers who started prescribing CS to a patient during the PHE and have never seen that patient in person may continue to prescribe CS to the patient for 180 days after May 11th
• New patients after May 11th: telemedicine providers may prescribe a 30-day supply of a CIII - V non-narcotic CS, but the patient must be seen in person before they can receive more. CII and narcotic CS cannot be prescribed over telemedicine. There is an exception for buprenorphine, which may be prescribed for 30 days before the in-person requirement.
• Telemedicine providers may prescribe CS to patients they have never seen in person if another medical provider (who saw the patient in person) refers the patient to them for CS management

• DEA telemedicine highlight sheet for medical providers

Most providers don't think of nose sprays when treating dry eyes, but a new drug hopes to change that. Tyrvaya is a nose spray recently approved for dry eyes that contains varenicline, the active ingredient in the smoking cessation drug Chantix. Studies show it is likely more effective than Restasis (cyclosporine), a heavily marketed eye drop that always had questionable efficacy. See the link below for a brief review.

• Tyrvaya (varenicline) nose spray for dry eyes

By now, most primary care providers have been asked to fill out paperwork declaring a patient's pet an emotional support animal. These requests have become so common that an entire industry of online businesses that provides these designations for a fee has come to exist. So what makes an animal "emotionally supportive," and why are patients often anxious to get the paperwork completed? We review the relevant housing and airline laws surrounding these requests so that providers understand their genesis.

• Emotional support animals - what providers should know