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Obese man sitting on curb after exercising

WEIGHT LOSS DRUGS - Where are we now?

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.

COVID-19 virus around person wearing mask

Study finds COVID-19 treatment Molnupiravir (Lagevrio®) offers no benefit in vaccinated patients

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.

Secukinumab (Cosentyx) found effective for hidradenitis suppurativa
Secukinumab (Cosentyx) trademark
Hidradenitis suppurativa (HS), a chronic condition marked by apocrine gland scarring and discharge, is notoriously difficult to treat. Humira, a tumor necrosis factor inhibitor, is the only FDA-approved treatment, and its effects are limited. Two studies published together in The Lancet found that Secukinumab (Cosentyx) was superior to placebo for moderate-to-severe HS, with about 46% of secukinumab-treated patients achieving a clinical response compared to 31 - 34% in the placebo group. Kineret and Stelara have also been shown to be effective in very small trials.

telemedicien over laptop


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

Study finds no difference between HCTZ and chlorthalidone
illustration of the kidneys
HCTZ is prescribed ten times more than chlorthalidone, but some experts have argued that chlorthalidone should be preferred because it has a longer half-life and more data from trials to support its effects. To test this assertion, a study (N=13,523) published in the New England Journal of Medicine randomized hypertensive VA patients (average age 72 years) who were taking HCTZ to continue with HCTZ or switch to chlorthalidone. After a median follow-up of 2.4 years, there was no significant difference between the groups for a composite outcome that included a number of cardiovascular endpoints. Hypokalemia was slightly more common in the chlorthalidone group (6% vs 4.4%).


Small study finds as-needed naltrexone helps reduce binge drinking

picture of bartender pouring shots
A small placebo-controlled trial (N=120) published in the American Journal of Psychiatry evaluated the effects of as-needed naltrexone (50 mg during alcohol cravings or when binge drinking was anticipated) on 4 different drinking outcomes in sexual and gender minority men. Naltrexone significantly improved 3 of the outcomes, including number of drinks in past 30 days (31% reduction), any binge drinking in the past week (17% reduction), and number of binge drinking days in the past week (26% reduction).

Benzodiazepines get updated pregnancy labeling

pregnant woman holding ultrasound image
For years, benzodiazepines have carried warnings that they are unsafe in pregnancy, and some have FDA pregnancy category D and X ratings. Recent label updates now state that there is no clear association between benzodiazepines and major birth defects. For women receiving benzodiazepines late in pregnancy, a warning about neonatal sedation and/or withdrawal was added.

Another study shows MRI-targeted prostate biopsies are the way to go

picture of doctor holding prostate cancer ribbon
For years, systematic ultrasound-guided biopsies that randomly sampled different areas of the prostate were the standard workup for an elevated PSA. Recent advances in MRI technology, however, have made MRI-targeted biopsies a reality. Two large studies [PMID 29552975, PMID 34237810] showed that MRI-targeted biopsies reduced the number of biopsy procedures and decreased overdiagnosis with very little loss of significant cancer detection. A third study (see link below) was recently published that validated these findings.

Vuity® (pilocarpine) eyedrops for age-related farsightedness

picture of an eye
Vuity® (pilocarpine) is an eyedrop recently approved to treat age-related farsightedness, a condition people often address with reading glasses. Even though it's a new drug with no generic, cash-pay prices are around $80 per bottle, which provides about 25 days of treatment. See the link below for a brief review of its effects.

Drug that delays type one diabetes approved

Vial of Tzield (teplizumab)
Teplizumab (Tzield®), a monoclonal antibody that alters T-cell affinity for pancreatic beta cells, was approved to delay the onset of type 1 diabetes (T1DM) in pediatric patients 8 years and older with two or more islet cell antibodies and dysglycemia. The drug is an IV infusion given once daily over 14 consecutive days.



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Tyrvaya® (varenicline) nose spray for dry eyes
woman using nose spray
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.
Emotional support animal laws - what providers should know
Dog on an airplane
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.


A 65-year-old male who had a CABG two years ago comes to see you for follow-up on a recent hospitalization for new-onset atrial fibrillation. In the hospital, he was started on Eliquis, and when you review his med list, you see that he is still taking a daily low-dose aspirin. Should you tell him to stop the aspirin now that he is on Eliquis? Should he take aspirin and Eliquis together since he has an indication for both? Are there any guidelines or studies that address the issue? Find out more at the link below.