DOI QR코드

DOI QR Code

An Overview of Existing and Emerging Weight-Loss Drugs to Target Obesity-Related Complications: Insights from Clinical Trials

  • Mi Kyung Kim (Department of Internal Medicine, Keimyung University, School of Medicine, Dongsan Hospital) ;
  • Hye Soon Kim (Department of Internal Medicine, Keimyung University, School of Medicine, Dongsan Hospital)
  • Received : 2024.11.18
  • Accepted : 2024.12.09
  • Published : 2025.01.01

Abstract

Obesity requires treatment as it is associated with health problems such as type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, and some cancers, which increase mortality rates. Achieving sufficient weight loss to reduce obesity-related diseases requires a variety of interventions, including comprehensive lifestyle modification of diet and exercise, change in behavior, anti-obesity medications, and surgery. To date, anti-obesity agents with various mechanisms of action have been developed, and mostly reduce energy intake, resulting in weight loss of about 5% to 10% compared to baseline. Recently developed drugs and those currently under development have been shown to reduce body weight by more than 10% and are expected to reduce obesity-related complications. This article summarizes existing and emerging anti-obesity medications, with a particular focus on those evaluated in clinical trials.

Keywords

Acknowledgement

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science, ICT and Future Planning (NRF-2021R1I1A3059150) and Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), fundedby the Ministry of Health & Welfare (HI22C0729), Republic of Korea.

References

  1. Allison, D. B., Gadde, K. M., Garvey, W. T., Peterson, C. A., Schwiers, M. L., Najarian, T., Tam, P. Y., Troupin, B. and Day, W. W. (2012) Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring) 20, 330-342.
  2. Aronne, L. J., Sattar, N., Horn, D. B., Bays, H. E., Wharton, S., Lin, W. Y., Ahmad, N. N., Zhang, S., Liao, R., Bunck, M. C., Jouravskaya, I. and Murphy, M. A; the SURMOUNT-4 Investigators (2024) Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA 331, 38-48.
  3. Bailey, C. J. (2021) Tirzepatide: a new low for bodyweight and blood glucose. Lancet Diabetes Endocrinol. 9, 646-648.
  4. Bergmann, N. C., Davies, M. J., Lingvay, I. and Knop, F. K. (2023) Semaglutide for the treatment of overweight and obesity: A review. Diabetes Obes. Metab. 25, 18-35.
  5. Boyle, C. N., Lutz, T. A. and Le Foll, C. (2018) Amylin - its role in the homeostatic and hedonic control of eating and recent developments of amylin analogs to treat obesity. Mol. Metab. 8, 203-210.
  6. Campbell, J. E. and Drucker, D. J. (2013) Pharmacology, physiology, and mechanisms of incretin hormone action. Cell Metab. 17, 819-837.
  7. Cegla, J., Troke, R. C., Jones, B., Tharakan, G., Kenkre, J., McCullough, K. A., Lim, C. T., Parvizi, N., Hussein, M., Chambers, E. S., Minnion, J., Cuenco, J., Ghatei, M. A., Meeran, K., Tan, T. M. and Bloom, S. R. (2014) Coinfusion of low-dose GLP-1 and glucagon in man results in a reduction in food intake. Diabetes 63, 3711-3720.
  8. Christoffersen, B. O., Sanchez-Delgado, G., John, L. M., Ryan, D. H., Raun, K. and Ravussin, E. (2022) Beyond appetite regulation: targeting energy expenditure, fat oxidation, and lean mass preservation for sustainable weight loss. Obesity (Silver Spring) 30, 841-857.
  9. Coskun, T., Sloop, K. W., Loghin, C., Alsina-Fernandez, J., Urva, S., Bokvist, K. B., Cui, X., Briere, D. A., Cabrera, O., Roell, W. C., Kuchibhotla, U., Moyers, J. S., Benson, C. T., Gimeno, R. E., D'Alessio, D. A. and Haupt, A. (2018) LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept. Mol. Metab. 18, 3-14.
  10. Coskun, T., Urva, S., Roell, W. C., Qu, H., Loghin, C., Moyers, J. S., O'Farrell, L. S., Briere, D. A., Sloop, K. W., Thomas, M. K., Pirro, V., Wainscott, D. B., Willard, F. S., Abernathy, M., Morford, L., Du, Y., Benson, C., Gimeno, R. E., Haupt, A. and Milicevic, Z. (2022) LY3437943, a novel triple glucagon, GIP, and GLP-1 receptor agonist for glycemic control and weight loss: from discovery to clinical proof of concept. Cell Metab. 34, 1234-1247.e9.
  11. Davies, M., Faerch, L., Jeppesen, O. K., Pakseresht, A., Pedersen, S. D., Perreault, L., Rosenstock, J., Shimomura, I., Viljoen, A., Wadden, T. A. and Lingvay, I.; STEP 2 Study Group (2021) Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet 397, 971-984.
  12. Davies, M., Pieber, T. R., Hartoft-Nielsen, M. L., Hansen, O. K. H., Jabbour, S. and Rosenstock, J. (2017) Effect of oral semaglutide compared with placebo and subcutaneous semaglutide on glycemic control in patients with type 2 diabetes: a randomized clinical trial. JAMA 318, 1460-1470.
  13. Enebo, L. B., Berthelsen, K. K., Kankam, M., Lund, M. T., Rubino, D. M., Satylganova, A. and Lau, D. C. W. (2021) Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2.4 mg for weight management: a randomised, controlled, phase 1b trial. Lancet 397, 1736-1748.
  14. Food and Drug Administration (2024) Drug Safety-related Labeling Changes (SrLC). Available from https://www.accessdata.fda.gov/scripts/cder/safetylabelingchanges/index.cfm?event=search Result.page [accessed 2024 Nov 1].
  15. Frias, J. P., Deenadayalan, S., Erichsen, L., Knop, F. K., Lingvay, I., Macura, S., Mathieu, C., Pedersen, S. D. and Davies, M. (2023) Efficacy and safety of co-administered once-weekly cagrilintide 2.4 mg with once-weekly semaglutide 2.4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial. Lancet 402, 720-730.
  16. Gadde, K. M., Allison, D. B., Ryan, D. H., Peterson, C. A., Troupin, B., Schwiers, M. L. and Day, W. W. (2011) Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet 377, 1341-1352.
  17. Garvey, W. T., Batterham, R. L., Bhatta, M., Buscemi, S., Christensen, L. N., Frias, J. P., Jodar, E., Kandler, K., Rigas, G., Wadden, T. A. and Wharton, S.; STEP 5 Study Group (2022) Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat. Med. 28, 2083-2091.
  18. Garvey, W. T., Frias, J. P., Jastreboff, A. M., le Roux, C. W., Sattar, N., Aizenberg, D., Mao, H., Zhang, S., Ahmad, N. N., Bunck, M. C., Benabbad, I. and Zhang, X. M.; SURMOUNT-2 investigators (2023) Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 402, 613-626.
  19. Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., Nadolsky, K., Pessah-Pollack, R. and Plodkowski, R.; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines (2016) American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity executive summary. Endocr. Pract. 22, 842-884.
  20. Greenway, F. L., Fujioka, K., Plodkowski, R. A., Mudaliar, S., Guttadauria, M., Erickson, J., Kim, D. D. and Dunayevich, E.; COR-I Study Group (2010) Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 376, 595-605.
  21. Greenway, F. L., Whitehouse, M. J., Guttadauria, M., Anderson, J. W., Atkinson, R. L., Fujioka, K., Gadde, K. M., Gupta, A. K., O'Neil, P., Schumacher, D., Smith, D., Dunayevich, E., Tollefson, G. D., Weber, E. and Cowley, M. A. (2009) Rational design of a combination medication for the treatment of obesity. Obesity (Silver Spring) 17, 30-39.
  22. Guerciolini, R. (1997) Mode of action of orlistat. Int. J. Obes. Relat. Metab. Disord. 21, S12-S23.
  23. Guo, W., Xu, Z., Zou, H., Li, F., Li, Y., Feng, J., Zhu, Z., Zheng, Q., Zhu, R., Wang, B., Li, Y., Hao, S., Qin, H., Jones, C. L., Adegbite, E., Telusca, L., Fenaux, M., Zhong, W., Junaidi, M. K., Xu, S. and Pan, H. (2023) Discovery of ecnoglutide - A novel, long-acting, cAMP-biased glucagon-like peptide-1 (GLP-1) analog. Mol. Metab. 75, 101762.
  24. Hojberg, P. V., Vilsboll, T., Rabol, R., Knop, F. K., Bache, M., Krarup, T., Holst, J. J. and Madsbad, S. (2009) Four weeks of near-normalisation of blood glucose improves the insulin response to glucagonlike peptide-1 and glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes. Diabetologia 52, 199-207.
  25. Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C. and Stefanski, A.; SURMOUNT-1 Investigators (2022) Tirzepatide once weekly for the treatment of obesity. N. Engl. J. Med. 387, 205-216.
  26. Jastreboff, A. M., Kaplan, L. M., Frias, J. P., Wu, Q., Du, Y., Gurbuz, S., Coskun, T., Haupt, A., Milicevic, Z. and Hartman, M. L.; Retatrutide Phase 2 Obesity Trial Investigators (2023) Triple-hormone receptor agonist retatrutide for obesity - a phase 2 trial. N. Engl. J. Med. 389, 514-526.
  27. Jeon, E., Lee, K. Y. and Kim, K. K. (2023) Approved anti-obesity medications in 2022 KSSO guidelines and the promise of phase 3 clinical trials: anti-obesity drugs in the sky and on the horizon. J. Obes. Metab. Syndr. 32, 106-120.
  28. Ji, L., Gao, L., Jiang, H., Yang, J., Yu, L., Wen, J., Cai, C., Deng, H., Feng, L., Song, B., Ma, Q. and Qian, L. (2022) Safety and efficacy of a GLP-1 and glucagon receptor dual agonist mazdutide (IBI362) 9 mg and 10 mg in Chinese adults with overweight or obesity: a randomised, placebo-controlled, multiple-ascending-dose phase 1b trial. EClinicalMedicine 54, 101691.
  29. Ji, L., Jiang, H., An, P., Deng, H., Liu, M., Li, L., Feng, L., Song, B., Han-Zhang, H., Ma, Q. and Qian, L. (2021) IBI362 (LY3305677), a weekly-dose GLP-1 and glucagon receptor dual agonist, in Chinese adults with overweight or obesity: a randomised, placebocontrolled, multiple ascending dose phase 1b study. EClinicalMedicine 39, 101088.
  30. Ji, L., Jiang, H., Cheng, Z., Qiu, W., Liao, L., Zhang, Y., Li, X., Pang, S., Zhang, L., Chen, L., Yang, T., Li, Y., Qu, S., Wen, J., Gu, J., Deng, H., Wang, Y., Li, L., Han-Zhang, H., Ma, Q. and Qian, L. (2023) A phase 2 randomised controlled trial of mazdutide in Chinese overweight adults or adults with obesity. Nat. Commun. 14, 8289.
  31. Kadowaki, T., Isendahl, J., Khalid, U., Lee, S. Y., Nishida, T., Ogawa, W., Tobe, K., Yamauchi, T. and Lim, S.; STEP 6 investigators (2022) Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol. 10, 193-206.
  32. Kawai, T., Sun, B., Yoshino, H., Feng, D., Suzuki, Y., Fukazawa, M., Nagao, S., Wainscott, D. B., Showalter, A. D., Droz, B. A., Kobilka, T. S., Coghlan, M. P., Willard, F. S., Kawabe, Y., Kobilka, B. K. and Sloop, K. W. (2020) Structural basis for GLP-1 receptor activation by LY3502970, an orally active nonpeptide agonist. Proc. Natl. Acad. Sci. U. S. A. 117, 29959-29967.
  33. Kim, K. K., Haam, J. H., Kim, B. T., Kim, E. M., Park, J. H., Rhee, S. Y., Jeon, E., Kang, E., Nam, G. E., Koo, H. Y., Lim, J. H., Jeong, J. E., Kim, J. H., Kim, J. W., Park, J. H., Hong, J. H., Lee, S. E., Min, S. H., Kim, S. J., Kim, S., Kim, Y. H., Lee, Y. J., Cho, Y. J., Rhie, Y. J., Kim, Y. H., Kang, J. H. and Lee, C. B.; Committee of Clinical Practice Guidelines, Korean Society for the Study of Obesity (KSSO) (2023) Evaluation and treatment of obesity and its comorbidities: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J. Obes. Metab. Syndr. 32, 1-24.
  34. Kim, S. J., Nian, C., Karunakaran, S., Clee, S. M., Isales, C. M. and McIntosh, C. H. (2012) GIP-overexpressing mice demonstrate reduced diet-induced obesity and steatosis, and improved glucose homeostasis. PLoS One 7, e40156.
  35. Knop, F. K., Aroda, V. R., do Vale, R. D., Holst-Hansen, T., Laursen, P. N., Rosenstock, J., Rubino, D. M. and Garvey, W. T.; OASIS 1 Investigators (2023) Oral semaglutide 50 mg taken once per day in adults with overweight or obesity (OASIS 1): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 402, 705-719.
  36. Kosiborod, M. N., Abildstrom, S. Z., Borlaug, B. A., Butler, J., Rasmussen, S., Davies, M., Hovingh, G. K., Kitzman, D. W., Lindegaard, M. L., Moller, D. V., Shah, S. J., Treppendahl, M. B., Verma, S., Abhayaratna, W., Ahmed, F. Z., Chopra, V., Ezekowitz, J., Fu, M., Ito, H., Lelonek, M., Melenovsky, V., Merkely, B., Nunez, J., Perna, E., Schou, M., Senni, M., Sharma, K., Van der Meer, P., von Lewinski, D., Wolf, D. and Petrie, M. C.; STEP-HFpEF Trial Committees and Investigators (2023) Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N. Engl. J. Med. 389, 1069-1084.
  37. Kosiborod, M. N., Petrie, M. C., Borlaug, B. A., Butler, J., Davies, M. J., Hovingh, G. K., Kitzman, D. W., Moller, D. V., Treppendahl, M. B., Verma, S., Jensen, T. J., Liisberg, K., Lindegaard, M. L., Abhayaratna, W., Ahmed, F. Z., Ben-Gal, T., Chopra, V., Ezekowitz, J. A., Fu, M., Ito, H., Lelonek, M., Melenovsky, V., Merkely, B., Nunez, J., Perna, E., Schou, M., Senni, M., Sharma, K., van der Meer, P., Von Lewinski, D., Wolf, D. and Shah, S. J.; STEP-HFpEF DM Trial Committees and Investigators (2024) Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes. N. Engl. J. Med. 390, 1394-1407.
  38. Kruse, T., Hansen, J. L., Dahl, K., Schaffer, L., Sensfuss, U., Poulsen, C., Schlein, M., Hansen, A. M. K., Jeppesen, C. B., Dornonville de la Cour, C., Clausen, T. R., Johansson, E., Fulle, S., Skyggebjerg, R. B. and Raun, K. (2021) Development of cagrilintide, a long-acting amylin analogue. J. Med. Chem. 64, 11183-11194.
  39. Lau, D. C. W., Erichsen, L., Francisco, A. M., Satylganova, A., le Roux, C. W., McGowan, B., Pedersen, S. D., Pietilainen, K. H., Rubino, D. and Batterham, R. L. (2021) Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial. Lancet 398, 2160-2172.
  40. Lau, J., Bloch, P., Schaffer, L., Pettersson, I., Spetzler, J., Kofoed, J., Madsen, K., Knudsen, L. B., McGuire, J., Steensgaard, D. B., Strauss, H. M., Gram, D. X., Knudsen, S. M., Nielsen, F. S., Thygesen, P., Reedtz-Runge, S. and Kruse, T. (2015) Discovery of the once-weekly glucagon-like peptide-1 (GLP-1) analogue semaglutide. J. Med. Chem. 58, 7370-7380.
  41. le Roux, C. W., Astrup, A., Fujioka, K., Greenway, F., Lau, D. C. W., Van Gaal, L., Ortiz, R. V., Wilding, J. P. H., Skjoth, T. V., Manning, L. S. and Pi-Sunyer, X.; SCALE Obesity Prediabetes NN8022-1839 Study Group (2017) 3 Years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet 389, 1399-1409.
  42. le Roux, C. W., Steen, O., Lucas, K. J., Startseva, E., Unseld, A. and Hennige, A. M. (2024) Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial. Lancet Diabetes Endocrinol. 12, 162-173.
  43. Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., Hardt-Lindberg, S., Hovingh, G. K., Kahn, S. E., Kushner, R. F., Lingvay, I., Oral, T. K., Michelsen, M. M., Plutzky, J., Tornoe, C. W. and Ryan, D. H.; SELECT Trial Investigators (2023) Semaglutide and cardiovascular outcomes in obesity without diabetes. N. Engl. J. Med. 389, 2221-2232.
  44. Marbury, T. C., Flint, A., Jacobsen, J. B., Derving Karsbol, J. and Lasseter, K. (2017) Pharmacokinetics and tolerability of a single dose of semaglutide, a human glucagon-like peptide-1 analog, in subjects with and without renal impairment. Clin. Pharmacokinet. 56, 1381-1390.
  45. Meier, J. J. (2012) GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat. Rev. Endocrinol. 8, 728-742.
  46. Milder, D. A., Milder, T. Y., Liang, S. S. and Kam, P. C. A. (2024) Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice. Anaesthesia 79, 735-747.
  47. Mu, Y., Bao, X., Eliaschewitz, F. G., Hansen, M. R., Kim, B. T., Koroleva, A., Ma, R. C. W., Yang, T., Zu, N. and Liu, M; STEP 7 Study Group (2024) Efficacy and safety of once weekly semaglutide 2.4 mg for weight management in a predominantly east Asian population with overweight or obesity (STEP 7): a double-blind, multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 12, 184-195.
  48. Padwal, R., Li, S. K. and Lau, D. C. (2004) Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst. Rev. 2003, CD004094.
  49. Perkovic, V., Tuttle, K. R., Rossing, P., Mahaffey, K. W., Mann, J. F. E., Bakris, G., Baeres, F. M. M., Idorn, T., Bosch-Traberg, H., Lausvig, N. L. and Pratley, R.; FLOW Trial Committees and Investigators (2024) Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N. Engl. J. Med. 391, 109-121.
  50. Pi-Sunyer, X., Astrup, A., Fujioka, K., Greenway, F., Halpern, A., Krempf, M., Lau, D. C., le Roux, C. W., Violante Ortiz, R., Jensen, C. B. and Wilding, J. P.; SCALE Obesity and Prediabetes NN8022-1839 Study Group (2015) A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N. Engl. J. Med. 373, 11-22.
  51. Pilitsi, E., Farr, O. M., Polyzos, S. A., Perakakis, N., Nolen-Doerr, E., Papathanasiou, A. E. and Mantzoros, C. S. (2019) Pharmacotherapy of obesity: available medications and drugs under investigation. Metabolism 92, 170-192.
  52. Qin, W., Yang, J., Ni, Y., Deng, C., Ruan, Q., Ruan, J., Zhou, P. and Duan, K. (2024) Efficacy and safety of once-weekly tirzepatide for weight management compared to placebo: an updated systematic review and meta-analysis including the latest SURMOUNT-2 trial. Endocrine 86, 70-84.
  53. Rubino, D., Abrahamsson, N., Davies, M., Hesse, D., Greenway, F. L., Jensen, C., Lingvay, I., Mosenzon, O., Rosenstock, J., Rubio, M. A., Rudofsky, G., Tadayon, S., Wadden, T. A. and Dicker, D.; STEP 4 Investigators (2021) Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA 325, 1414-1425.
  54. Rubino, D. M., Greenway, F. L., Khalid, U., O'Neil, P. M., Rosenstock, J., Sorrig, R., Wadden, T. A., Wizert, A. and Garvey, W. T.; The STEP 8 Randomized Clinical Trial (2022) Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA 327, 138-150.
  55. Samms, R. J., Coghlan, M. P. and Sloop, K. W. (2020) How may GIP enhance the therapeutic efficacy of GLP-1? Trends Endocrinol. Metab. 31, 410-421.
  56. Sandoval, D. A. and D'Alessio, D. A. (2015) Physiology of proglucagon peptides: role of glucagon and GLP-1 in health and disease. Physiol. Rev. 95, 513-548.
  57. Sanyal, A. J., Bedossa, P., Fraessdorf, M., Neff, G. W., Lawitz, E., Bugianesi, E., Anstee, Q. M., Hussain, S. A., Newsome, P. N., Ratziu, V., Hosseini-Tabatabaei, A., Schattenberg, J. M., Noureddin, M., Alkhouri, N. and Younes, R.; 1404-0043 Trial Investigators (2024) A phase 2 randomized trial of survodutide in MASH and fibrosis. N. Engl. J. Med. 391, 311-319.
  58. Torgerson, J. S., Hauptman, J., Boldrin, M. N. and Sjostrom, L. (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27, 155-161.
  59. Urva, S., Coskun, T., Loh, M. T., Du, Y., Thomas, M. K., Gurbuz, S., Haupt, A., Benson, C. T., Hernandez-Illas, M., D'Alessio, D. A. and Milicevic, Z. (2022) LY3437943, a novel triple GIP, GLP-1, and glucagon receptor agonist in people with type 2 diabetes: a phase 1b, multicentre, double-blind, placebo-controlled, randomised, multiple-ascending dose trial. Lancet 400, 1869-1881.
  60. Veniant, M. M., Lu, S. C., Atangan, L., Komorowski, R., Stanislaus, S., Cheng, Y., Wu, B., Falsey, J. R., Hager, T., Thomas, V. A., Ambhaikar, M., Sharpsten, L., Zhu, Y., Kurra, V., Jeswani, R., Oberoi, R. K., Parnes, J. R., Honarpour, N., Neutel, J. and Strande, J. L. (2024) A GIPR antagonist conjugated to GLP-1 analogues promotes weight loss with improved metabolic parameters in preclinical and phase 1 settings. Nat. Metab. 6, 290-303.
  61. Wadden, T. A., Bailey, T. S., Billings, L. K., Davies, M., Frias, J. P., Koroleva, A., Lingvay, I., O'Neil, P. M., Rubino, D. M., Skovgaard, D., Wallenstein, S. O. R. and Garvey, W. T.; STEP 3 Investigators (2021) Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial. JAMA 325, 1403-1413.
  62. Wadden, T. A., Chao, A. M., Machineni, S., Kushner, R., Ard, J., Srivastava, G., Halpern, B., Zhang, S., Chen, J., Bunck, M. C., Ahmad, N. N. and Forrester, T. (2023) Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nat. Med. 29, 2909-2918.
  63. Wen, X., Zhang, B., Wu, B., Xiao, H., Li, Z., Li, R., Xu, X. and Li, T. (2022) Signaling pathways in obesity: mechanisms and therapeutic interventions. Signal Transduct. Target. Ther. 7, 298.
  64. Wharton, S., Blevins, T., Connery, L., Rosenstock, J., Raha, S., Liu, R., Ma, X., Mather, K. J., Haupt, A., Robins, D., Pratt, E., Kazda, C. and Konig, M.; GZGI Investigators (2023) Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N. Engl. J. Med. 389, 877-888.
  65. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N. and Kushner, R. F.; STEP 1 Study Group (2021) Once-weekly semaglutide in adults with overweight or obesity. N. Engl. J. Med. 384, 989-1002.
  66. Wilding, J. P. H., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K. and Kushner, R. F.; STEP 1 Study Group (2022) Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes. Metab. 24, 1553-1564.
  67. World Health Organization (2024) Fact sheets, obesity and overweight. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight/ [accessed 2024 Mar 1].
  68. Zakariassen, H. L., John, L. M. and Lutz, T. A. (2020) Central control of energy balance by amylin and calcitonin receptor agonists and their potential for treatment of metabolic diseases. Basic Clin. Pharmacol. Toxicol. 127, 163-177.
  69. Zhao, L. I. N., Zhu, D. A. N., Liu, D., Pan, T., Wang, D., Hui, Y., Ling, H., Cai, H., Zeng, M., Zuo, Y. U. E., Sun, Y., Wang, Y. and Li, X. (2024) 1861-LB: efficacy and safety of HRS9531, a novel dual GLP-1/GIP receptor agonist, in obese adults—a phase 2 trial. Diabetes 73, 1861-LB.
  70. Zhu, D., Wang, W., Tong, G., Ma, G., Ma, J., Han, J., Zhang, X., Liu, Y., Gan, S., Qin, H., Zheng, Q., Ning, J., Zhu, Z., Guo, M., Bu, Y., Li, Y., Jones, C. L., Fenaux, M., Junaidi, M. K., Xu, S. and Pan, H. (2024) Efficacy and safety of GLP-1 analog ecnoglutide in adults with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial. Nat. Commun. 15, 8408.
  71. Zimmermann, T., Thomas, L., Baader-Pagler, T., Haebel, P., Simon, E., Reindl, W., Bajrami, B., Rist, W., Uphues, I., Drucker, D. J., Klein, H., Santhanam, R., Hamprecht, D., Neubauer, H. and Augustin, R. (2022) BI 456906: Discovery and preclinical pharmacology of a novel GCGR/GLP-1R dual agonist with robust anti-obesity efficacy. Mol. Metab. 66, 101633.