Q&A: Understanding Benefits, Managing Adverse Effects of GLP-1 Receptor Agonists

Robert Kushner, MD, MS, professor of medicine and medicine education at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, sat down with Drug Topics ahead of the American Society for Preventive Cardiology Congress on CVD Prevention to discuss the benefits of glucagon-like peptide-1 (GLP-1) therapies and highlighted some strategies for management of adverse effects.

Drug Topics: What patient populations are most likely to benefit from glucagon-like peptide-1 (GLP-1) receptor agonists for obesity management, and what criteria should be considered when recommending these medications?

GLP-1 therapies are effective, but are associated with gastrointestinal adverse effects. | image credit: Corona Borealis - stock.adobe.com

Robert Kushner, MD, MS: Incretin-based medications, such as GLP-1s or glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 dual agonists—can be effective for any individual who comes in who is seeking to improve their health, in part, through weight loss. We think about it as a candidate for almost any individual.

READ MORE: Pfizer Advances Oral GLP-1 Development as the Race for Second-Gen Obesity Therapies Continues

However, there are those…who come in with complications or comorbid conditions, who would really benefit from more effective medication. Instead of losing just 5% or 6% body weight, which may improve blood pressure [and] blood sugar, [or] other conditions such as sleep apnea, fatty liver disease…[and] cardiovascular risks—really do need to lose even more weight. That's when these incretin-based medications come to mind as preferable agents over the earlier approved, centrally acting medications.

Drug Topics: What are the most common side effects of glucagon-like peptide-1 (GLP-1) receptor agonists, and what strategies can be used to help patients manage these adverse effects?

Kushner: The most common adverse effects of these incretin-based medications are gastrointestinal; it's kind of a class action side effect for all of these medications.

What we're talking about is nausea, diarrhea, constipation, potentially vomiting, and heartburn. These adverse effects can be mitigated or reduced by slowly escalating the dose—which is exactly what's in the package insert—by keeping close contact with the patient, and [by not] dose escalating while they're still having adverse effects.

We have learned through conducting phase 3 trials that we can significantly reduce these adverse effects by…counseling on a healthy diet. Reduce the amount of fat or fatty foods in the diet; don't eat until you're beyond excessively full—in other words, small meals. Don't skip meals; plan ahead so that you’re not going long hours without eating, keeping yourself well hydrated.

READ MORE: Teva Pharmaceuticals Launches Liraglutide 1.8 mg, First Generic GLP-1 in the US

Since [these medications are] once a week injections, plan on taking the injection around a time where you have control of your diet for the next 1 to 2 days. In other words, if you go out on the weekends, and that’s when you’re eating out in restaurants most of the time, don't take the medication on a Friday night or Saturday morning. Similarly, if you're working out with a personal trainer, don't take the medication the day before, where you may become dehydrated or nauseated when you see your personal trainer or when you're exercising. With some forethought and guidance, we're very successful in getting individuals on this medication and escalating them over the first few months.

The American Society for Preventive Cardiology Congress on CVD Prevention was held August 2 to August 4 in Salt Lake City, Utah. Click here for more of our coverage.