Subscribe | Straight Healthcare
February 1, 2024
doctor measuring obese abdomen

PATIENTS GAIN WEIGHT BACK AFTER STOPPING GLP DRUGS

Wegovy and Zepbound are all the rage as Americans struggle to contain their waistlines. At their highest doses, weight loss over a year averages 16% with Wegovy and 21% with Zepbound, which rivals the effects of sleeve gastrectomy. Two studies have now looked at what happens when people stop these medications. In the first one, 902 overweight adults (average BMI 38) were treated with Wegovy for 20 weeks and lost 10.6% of their body weight. They were then randomized to continue Wegovy or switch to placebo for an additional 48 weeks. At the end of the randomization phase, Wegovy-continuers lost an additional 7.9%, while the placebo group gained back 6.9%. In a similar study, 670 patients (average BMI 38) received Zepbound for 36 weeks, achieving an average weight loss of 20.9%. They were then randomized to continue Zepbound or switch to placebo for 52 weeks. At the end of the study, Zepbound-continuers lost an additional 5.5%, while the placebo group gained back 14%.

The results of these studies aren't surprising, given that once the medications wear off, appetite is no longer suppressed, and patients who struggled with overeating before return to their previous habits. Many patients don't want to take these medications for life, which brings them back to where all weight-loss journeys seem to begin and end - diet and exercise. As for those who complain about the drug prices, calorie counting and jogging around the block are free.

New topical ED treatment Eroxon® available over the counter

Eroxon, an FDA-approved topical gel used to treat ED, is now widely available over the counter. A small amount is applied to the head of the penis, where it purportedly "stimulates nerve endings" as it evaporates, causing an erection within 10 minutes. It contains no active ingredient and is considered a medical device. Eight single-dose tubes cost $100 on Amazon, where, so far, the reviews are lousy.

Pneumococcal vaccine recommendations - there's an app for that

For years, there were two pneumococcal vaccines, now there are four. Figuring out which vaccine to give, how many, and what to do with the previously vaccinated can be perplexing. To help with the confusion, the CDC has created an online and mobile app that tells which vaccine to administer based on the patient's age, medical conditions, and prior vaccination history.

STUDIES EVALUATE ANTITHROMBOTICS FOR ATRIAL FIBRILLATION PRECURSORS

Traditionally, atrial fibrillation (AF) has been diagnosed with ECGs, telemetry, or holter monitors that provide days of tracings. In the past 20 years, new implantable devices (e.g., loop recorders, implantable defibrillators, pacemakers) have been introduced that give continuous readings over months to years. Longer tracings are able to detect asymptomatic episodes of atrial tachyarrhythmias that have undetermined clinical significance. Two events that have been loosely defined are atrial high-rate episodes (AHRE) and subclinical AF. While criteria aren't standardized across professional organizations, the following definitions are often seen:

  • AHRE - atrial tachyarrhythmia episodes with a rate > 170 beats/min detected by cardiac implantable electronic devices
  • Subclinical AF - an asymptomatic AHRE lasting greater than 6 minutes and less than 24 hours

Observational studies have found these events, which often precede the development of clinical AF, are associated with a higher-than-normal but less-than-AF stroke risk, spurring two recent studies that evaluated the effects of antithrombotics in affected patients. The first study (N=2536) compared edoxaban to placebo in patients with AHREs. It was stopped early due to futility, as CV events were not significantly lower with edoxaban, and major bleeding was worse. The other study (N=4012) randomized patients with subclinical AF to apixaban or aspirin. After 3.5 years of follow-up, apixaban reduced stroke risk (0.78%/patient-year vs 1.21%/patient-year) but increased major bleeding (1.53%/patient-year vs 1.12%/patient-year).

These studies do not support anticoagulation in AHRE or subclinical AF, while recent AHA guidelines state that it is "reasonable" in certain high-risk patients. Over the course of both trials, a significant number of subjects developed clinical AF (18% and 24%, respectively), underpinning the importance of continued close monitoring.