Dr Robert Zimmerman Discusses Challenges, Adverse Effects of GLP-1 and Multi-Agonist Therapies

Robert Zimmerman, MD, endocrinologist and director of the diabetes center in the department of endocrinology, diabetes, and metabolism at Cleveland Clinic, discussed the potential drawbacks of these interventions and the obstacles that providers and patients can encounter with glucagon-like peptide-1 (GLP-1) inhibitors and multi-agonist therapies.

Zimmerman recently presented on GLP-1 and multi-agonist therapies that have been indicated for both diabetes and obesity during an Institute for Value-Based Medicine® event hosted in conjunction with Cleveland Clinic.

Transcript

This transcript has been lightly edited for clarity and length.

Can you discuss any potential drawbacks to GLP-1/multi-agonist interventions?

The major problems that people have associated with GLP-1 agonists are gastrointestinal side effects. They most commonly cause nausea, sometimes cramping, and sometimes diarrhea. And I would say that most of the time, if somebody is unable to tolerate the medication, it is either due to severe nausea or to severe abdominal cramping. And I would say that those are the major complications that we see with the GLP-1 agonist.

What are the challenges or considerations in developing multi-agonist therapies for clinical use?

There’s 2 major problems associated with these agents. In terms of the problems, one is that they're expensive. And so, many insurance companies make it difficult to utilize them and some of them don't have these agents on their formulary. And because they're expensive, it's very hard to be able to afford these agents if you don't have insurance that covers them.

And the other problem is they are so popular that many of the companies that are making the GLP-1 agonists, despite the cost, are having trouble keeping up with the demand. And so, it's not uncommon that we order a particular agent and we get back saying they don't have available that particular dose of the drug, or they don't have that drug available at all, asking if we can pick a different agent. And from a physician perspective, if you go through the whole process of trying to get one of them approved, and then you can't get it at the pharmacy, that's a problem. So those are really the major problems that we're having associated with the drugs.