geoffrey modest medical blogs

  A recent article found tirzepatide to be superior to semaglutide in obese patients without diabetes, in this drug company sponsored and designed trial (see  tirzepatide vs semaglutide obesity no diabetes NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2416394)   Details : -- 750 individuals with obesity but without diabetes were randomized to maximum tolerated doses of tirzepatide (10 or 15 mg) or semaglutide (1.7 to 2.4mg) weekly in this 72 week  phase 3b, open-label, controlled trial of adults, in 32 sites in the US and Puerto Rico     -- all were at least 18yo, had BMI of at least 30 or 27 with at least one obesity complication (hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease) and at least one unsuccessful dietary effort for weight reduction -- mean age 45 (8% at least 65yo), 65% females, 76% white/19% Black/26% Hispanic -- BMI 39 (69% had BMI at least 35), 113 kg, duration of obesity 16 years -- prediabetes 57%, 50...

  A study from the recent Am Heart Assn meeting confirmed that tirzepatide leads to fewer cardiovascular events in patients having heart failure with preserved ejection fraction (HFpEF) and obesity, in the SUMMIT trial, a drug company supported trial (see   heart failure preserved tirzep NEJM2024  in dropbox, or  DOI: 10.1056/NEJMoa2410027)   Details : -- 731 participants who  were at least 40yo with heart failure, a left ventricular ejection fraction (LVEF) of at least 50% and a BMI of at least 30 in an international, double-blind RCT were recruited between April 2021 and June 2023     -- all participants had to have a 6-minute walk distance of 100-425 meters; a Kansas City Cardiomyopathy Questionnaire clinic summary score of 80 or less (scores range from 0-100, the higher scores reflecting a better quality of life); and at least one of an elevated N-terminal pro-B type natriuretic peptide (NT-proBNP) level (defined as >200 pg/m...