Speaker 1: Hello, this is the Itchy and Bitchy Podcast because being
itchy is bitchy and our medical system sucks. I'm doctor
Keith Milica, a vetnary, allergist and dermatologist.
Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and
a Q Care nurse practitioner.
Speaker 1: Send us your questions at ask at itch not dot com.
We love you, but we're not your doctors. The information
we discuss is not direct medical advice. Please talk to
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send us a question at a at itchno dot com. Thanks, hello,
doctor Miller, how's it going.
Speaker 2: Hi? Welcome to all of our listeners. I'm so glad
we're back together.
Speaker 1: Yes, and we're now posting on Mondays, so look for
the uploads on Monday morning.
Speaker 2: And we hope that you will go on our Facebook
site which I and B Podcast.
Speaker 1: And send us a question that ask at itch not
dot com Okay, so.
Speaker 3: Are you ready?
Speaker 1: Yeah, Okay, this is going to be a whirlwind because
this is the craziest, most amazing thing I can think of.
There are three major events that I know of in
my lifetime sort of in my lifetime that absolutely revolutionized
medicine as we know.
Speaker 3: It just totally changed the human species.
Speaker 2: Detail it soundsl.
Speaker 1: So the first is antabotics. What have antibotics done for humans?
Doctor Miller cured like death, repentuated eighty percent society, So antibotics.
The second most tragic, crazy thing that happened total misadventure
is the lidamide. So this was in the nineteen fifties
and sixties during the valium culture. Mother's Little Helper, make
you happy, and so thalidamide was an anti vomit morning
sickness drug and it turned out to cause horrible birth defects.
Luckily our FDA, which some people don't like very much,
but they did not approve in the United States, so
a lot of American babies were spared from the limb deformities.
But thalidamide was this amazing feel good drug in the
fifties and sixties for pregnant women, but caused horrible birth
defects and a whole generation of birth defects. So horrible,
horrible misadventure. But what's crazy amazing, like the best of
times the worst of times, is this gel one revolution.
And I have not seen any other drug or treatment
that falls into this kind of crazy madness of exploration
and benefits. And so we're going to talk about GLP
ones again. This is an updated version. Karen Nicol did
a really good episode previously, check that out if you
would like. But things have changed in months, definitely within
the last year. But every week there's new and new things.
So we're going to divide this episode into sort of
an introduction and then what GLP ones are actually approved
for and how that sort of got started, and then
we're going to take a break and come back and
talk about all of the possibilities and the proposed mechanisms.
A lot of them are thought of and sort of
hinted at by response to therapy, but not documented in
really good clinical statistical trials. And then we're going to
have a last segment of the possible side effects, which
are kind of interesting when you start thinking about mechanisms
of how the GLP actually works.
Speaker 2: And for our listeners, that don't know. What GLP one
receptor agonists are is glucagon like peptide receptor agonists, and
so these offer all kinds of benefits for metabolic, cardiovascular, renal,
and weight related benefits. So we'll we'll dive in.
Speaker 1: Yeah, so glucagon is produced in the liver, and agonist
means that we're going to stimulate the receptors and so
molecularly that's how these things work.
Speaker 3: And so we started off.
Speaker 1: Do you remember when they first got approved three years
ago maybe four?
Speaker 3: Yeah, so so.
Speaker 1: Not that long ago in the grand scheme of things,
and they were first approved. You remember the first drug
that was approved.
Speaker 2: The first one was sex Sinda and.
Speaker 3: It was approved for weight loss. Weight lossbetes that.
Speaker 2: They are a glue tide. It was indicated for what
loss Victosa, which was the branded other version. With all
of these classes, they get branded in different ways, and
so the branding of Victosa was to decrease cardio event
cardiovascular event reduction in patients with diabetes and established cardiovascular disease.
Speaker 1: So very specific prescribing guidelines, and so I would bet
that when it first came out, you didn't really prescribe
it to a huge number of patients.
Speaker 2: On the cardiology side. We didn't dive in initially.
Speaker 1: That's accurate, okay, So and this is just kind of
back up a step, and then we're going to take
a short break and come back with more detail. But
to back up a step, this is one of the peptides.
And peptides are all trendy now, but you need to
kind of understand what peptides are. They're simply proteins that
are found in the human body and interesting like other
drugs that are patented and drug companies like Pfizer or
Eli Lilly can have a patent on it. The Supreme
Court decided that these peptides are human proteins because they're
part of the human normal anatomy system, that they're not patentable.
So these peptides are very specific and they have pros
and cons They have benefits and side effects depending on
exactly what the peptide is and what it does. So
we're going to take a short break here and then
we're going to come back and talk about the proposed
and approved guidelines and treatment possibilities for these glp ones.
Speaker 3: Stick with us.
Speaker 1: It gets really interesting and really crazy from here. It's
magical medicine moments. So hang with us.
Speaker 3: All right, we're back. I hope he stayed with us.
Speaker 1: So now we're going to talk about all of the
different proposed treatments and treatments for these GLP ones and
it gets it gets really interesting. So just as crazy
as antibotics and pholidamide, where these GLP one started off
with this little bitty niche kind of treatment protocol and
now it is just crazy what they're showing to have
benefits for. So from the data side of things, Stephen,
what what are they actually used for and prescribed for?
Speaker 3: Right now?
Speaker 2: Yeah, so follow me into the weeds a moment.
Speaker 3: Yes, I like weeds. Yeah, data is good, give me
a good action.
Speaker 2: And so initially we talked about sex and and nick tosa,
and then the next generation was seema glue tide, which
was ozimpic, and then Rightbelsa's and we go by and
they're all it's interesting how as they've been branded, they
the branding has has been approved for certain different indications.
And so this is why people will meet barriers at
the pharmacy counter if the drugs not written under the
certain indication that it's approved for. And so for example,
we go V is for weight management and obesity with
weight related comorbidities, which is kind of a broad label and.
Speaker 1: That could be anything from diabetes, pre diabetes, even cancer
is related to abusie.
Speaker 2: It is also indicated for cardiovascular event reduction and obese
patients with established cardiovascular disease, so anybody with atherosclerosis. And
then it is also indicated for metabolic dysfunction with fatty
liver disease, specifically looking more into fibrosis of the liver.
Speaker 1: So glucagon is liver produced and so that's where this
whole mechanism kind of.
Speaker 3: Resides in the body. So how do they so all
of these peptides are similar in cross reaction.
Speaker 2: Yeah, so it wasn't done because they have to give indications.
Speaker 1: Right, but do the pharmacist and the providers if so,
if they have a lot of overlap, but are they prescribing?
You want you want treatment A, and so you do
drug A, and you want treatment B, so you do
drug B even though both drugs will do A.
Speaker 3: That's great.
Speaker 2: And so in the clinical setting, if you are prescribing,
say for example, you're prescribing zep bound, which is tears
zeppatide and it's approved for chronic weight management and obstructive
sleep apnea. And if the patient doesn't have those disease processes,
but yet they may have cardiovascular disease, then they would
be covered for we go Vy, which has the cardiovascular indication.
Speaker 1: So that becomes an insurance paperwork kind of thing. But
as far as the drug is actually the mechanism of action,
does it really matter which one tick and then some
maybe once you're next summer, once a day. They now
have oral drugs because it's much cheaper and easier to administer,
so their injecting devices are actually quite expensive.
Speaker 2: Yeah, so there's oral we go Vi, which is now available.
There's Rybelsis, which is semaglutide as well, and it has
the indications for diabetes cardiovasco or men reduction in patients
with type two diabetes melitis.
Speaker 1: So we're kind of in this situation where we have
lots of different drugs and the paperwork kind of regulates
which drug gets which diagnosis and which treatment, but in reality,
all of the drugs kind of do similar things and
they have an expanding list of benefits.
Speaker 2: Yeah, so patients just need to discuss this with their
prescribing provider to make sure that whatever drug is written
is written under the labeling that's appropriate.
Speaker 1: Okay, otherwise you're going to get pushed back from your
insurance company.
Speaker 3: That's right. So I'm going to.
Speaker 1: Read a list of all of the proposed theoretical benefits
that may or may not have been proven with really
good statistical studies based on tens of thousands of people.
But I want you first to tell me what the
actual approved indications are.
Speaker 2: So really you want to break the benefits down into
three major categories, or four major categories. One is glycemic.
Speaker 3: Control, which is sugar dibe.
Speaker 2: Like glucose, and the other is weight loss, The other
is cardiovascular benefits, and then of course renal protection, and
then I left off one, which is the fatty liver indication.
Speaker 1: Okay, So those are the indications. But what gets really
crazy and why this drug is so amazing is that
it's one of the moments in medicine where the expected
benefits were fairly narrow and limited, and then what the
patients are actually experiencing has just exponentially exploded. So under
weight loss, for instance, your joints get better. Under weight loss,
your libido gets better. So it's just this crazy exponential,
expansive list of benefits that these drugs have, even into depression, anxiety,
drug addiction.
Speaker 2: So on my end, I really pitt because I'm work
in cardiology. You look at just so, cardiovascular death as
the number one leading cause of death in the United States, right,
So they did this meta analysis, which was ten clinical
trials looking at seventy three hundred and fifty one patients.
That's a huge number of patients. And so major adverse
cardiovascular events such as stroke, cardiovascular death, and non fatal
am I were reduced by fourteen percent, heart failure hospitalizations
were reduced by fourteen percent, and then all cause mortality
for dying from anything was reduced by about twelve percent.
So just looking at the one indicated group, the major
reductions in depth are impressive with this drug class.
Speaker 1: Yeah, and anything above ten percent is really pretty significant.
So Okay, we're going to take a short break and
then we're going to come back and talk about the
other benefits. So if they look at these studies and
they're more and more of them, So we have now
hundreds of thousands of patients globally that are on these medications,
and what they do is they say, well, what else
is happening in these groups of patients? So anything above
ten percent is really impressive. But when we come back,
we're going to talk about some of these unexpected things,
like a thirty percent reduction in cancer risk.
Speaker 2: And I think it's really really important for our listeners
to understand that when we're looking at some of these benefits,
that most of those things are coming out of subgroup
analysis from these studies. So it may not be the
indication for the drug, but certainly benefit was seen and.
Speaker 1: More evidence is needed before it's a proven So we
have correlation but not causation yet. Okay, we're going to
take a break and then we're going to come back
and talk about these kind of amazingly weird, crazy things
that this drug therapies can do. Okay, hang tight and
join us on the other side. Hey, I hope you
made it back with us.
Speaker 3: So what we're going to do is I'm going.
Speaker 1: To read a list of all of the proposed benefits
and doctor Miller here is going to chime in with
some data if he has any kind of opinion about it.
So I looked up on Claude. Actually is what I've
switched to you now from chat, and I came up
with sixty five different proposed benefits of GLP one and
they're grouped into kind of specific organ systems. So cardiovascular
benefits are pretty well done.
Speaker 2: So we already yeah, we already touched on.
Speaker 1: That, and that's that's even down to like reduced hospitalization
visits associated reduced hypertension, and then metabolic benefits, which are
global and these are going to be related to weight
loss and sugar insulin diabetes, and when you start affecting
in a beneficial manner, that whole pathway, it pretty much
relates to everything else. It relates to sex, drive, to joints, exercise,
just pretty much whole morbidity, which is your overall disease.
Accumulation is improved. Hepatic disease. So you mentioned fatty liver disease,
but actually liver enzymes will go down, so if you
have any kind of associated with liver issues.
Speaker 2: And the day Lily is strong on that in that
the indication for these drugs is there for fatty liver disease.
You skipped over the whole renal I'm.
Speaker 1: Getting there, okay, yeah, okay, So and we'll come back
to renal disease. So you know, kidneys, Like, who would
think that kidneys are I wouldn't think that kidneys are
associated with like weight loss drug But so how are
kidneys benefited?
Speaker 2: Yeah, so GLP one a's decreased micro albumin area or
albuminary and slow EGFR decline. There's a particular study called
the Flow trial which looked at semaglue tide and it
showed there was a twenty four percent reduction in kidney
outcomes such as EGF to our decline, kidney failure, and
kidney slash cardiovascular death. So pretty four percent.
Speaker 1: So he said a lot of that's really he works there. Yeah,
anything about ten percent is impressive. So what he's basically
talking about is how well the kidney processes fluids and
toxins and GFR is glomyl glomerular filtration rates, and that's
kind of what the kidney does, It filters out.
Speaker 2: And there was a meta analysis, by the way of
all of that data, which is a huge It still
seventeen percent reduction and composite kidney outcomes across the class.
So that's a fairly impressive.
Speaker 1: And who would have thought kidneys so neurologic disorder, so
alcoholism and liver disease. That kind of makes sense that
if you're improving liver function, that doesn't mean We were
talking with our friends last night who are into all
of these vitamin supplements to improve their health, and I
pointed out that the biggest improvement would be to stop
drinking alcohol, which is a neurotoxin.
Speaker 2: YEA, So I will point out to our audience that
they're yes in the subgroup analysis there, which means not
the primary outcome for the trial, but they broke down
the subgroups and they looked at people's alcohol intake, and
early signals were found for reducing alcohol and substance use,
although this is not totally clear and needs further investigation.
Speaker 1: So I was talking about liver health and the effect
of the toxic alcohol, and we're recording this as we're
having a glass of wine, so we definitely are not
anti alcohol, but so the liver health benefits. But you're
actually talking about behavior and addiction. So the amount of
alcohol consumed, and this also happens with weight, that the
food drive, the annoying, obsessive, compulsive food thoughts get reduced,
and this is a huge impact on addiction.
Speaker 2: Yeah, the central nervous system effects are not clearly understood
yet and so certainly need further investigation.
Speaker 1: Yeah, but the benefits for addictive behaviors, even shopping addiction,
porn addiction, There are all of these sort of hints
that these drugs may be beneficial.
Speaker 2: So again in the subgroups where we looked at trends
on the forest plots, we saw that the data trended
toward the SGLT two our GLP one.
Speaker 3: A yeah crazy, so okay, And what about Alzheimer's.
Speaker 2: So neuro degenerative disease. The preliminary evidence suggests some potential
benefits in preventing dimension improving Parkinson's disease. Again, these are
investigational poorly understood, but when you looked at subgroups, certainly
there was some indication that this needed to be evaluated further.
Speaker 3: Do we have a proposed mechanism?
Speaker 2: Is it?
Speaker 3: We don't.
Speaker 2: Again, the whole central nervous system impact of this class
is poorly understood.
Speaker 1: And this is just what blows my mind is that
you know, this was launched for a very narrow, limited
diagnosis set and just the potential impact. I mean, there
are even discussions if you know entire populations. If every
American citizen or Australian or Canadian should be put on
these drugs just for overall health and well being, it's
just amazing. So okay, respiratory impact. So you mentioned sleep apnea,
So how is that benefit.
Speaker 2: Tears zeppetide is approved for obstructive sleep apnea? Is a
web bound Well we don't know. Again, so there's the
whole central nervous system piece that we don't understand. But
then there's also that with obesity comes this pickwick in physiology,
which is where the diaphragm so they really excurred and
so then it's nine.
Speaker 1: Predominal fat and you just mechanically can't breathe.
Speaker 2: Yeah, So it's indicated for moderate to severe abstruct restrictive
sleep apney and patient in adults with obesity.
Speaker 1: So even going to like arthritis and knee osteoarthritis and
pain and cartilage degeneration. And that's probably related to weight
that if you lose one hundred pounds with these drugs,
then that's one hundred pounds less that your knees have
to absorb.
Speaker 2: Yeah, So there is symptomatic improvement with this class in
knee specifically knee osteoarthritis, and we think that is probably
related to, you know, just the weight tension on the joint,
although we just don't know.
Speaker 1: Okay, women's mental stricles become more stable and predictable and regulated.
Speaker 3: What the hell's up with that?
Speaker 1: Like, how does a weightless drug cause better menstrual suz.
Speaker 2: So if you just think about it, that is where
hormones are stored, right, and so then you start reducing
fatty tissue in central obesity, and then you start shifting
hormones and so people do have some hormonal shift that occurs.
Speaker 1: Again, this just blows my mind. This is one of
the most amazing things I've ever even contemplated. We talked
about neurodegenerative diseases like Alzheimer's.
Speaker 3: What about stroke reduction? Is there any benefit for that?
Speaker 2: The drugs are indicated for cardiovascular event reduction, which includes stroke,
so of all cardiovascular disease, so that's included there yet Okay.
Speaker 1: And then I've talked about my chronic migraines. This is
researching this. I learned this that there's actually some evidence
that migraines become less severe and less episodic, so fewer
migraines per month on these trucks.
Speaker 2: Yeah, so this is evidence coming from the subgroup analysis
and again poorly understood, not absolutely indicated, So make sure
our audience understands that, but also knowing that there is
some potential potential for improvement in those symptoms.
Speaker 1: Just so I've rethought starting to take these. I'm not
terribly obese, and actually I'm very sensitive to the side effects,
which we're going to cover in the next section. But
I've actually restarted these for my migraines. I've had horribly
uncontrolled migraines. Okay, so then what about reproductive benefits. We
talked about the menstrual cycles that reproductive fertility seems to
be increasing in this way.
Speaker 2: Yeah, so again, you know, you look at something when
you look at a syndrome like PCOS polycystic ovarian syndrome,
which can contribute to some infertility issues, and it's kind
of a pre diabetic state and that impacts fertility. Again,
fatty tissue stores hormones and shifts hormones, and so we
just don't really know, but there is some some data
and evidence in the subgroups to indicate there might be
some benefit there. Just mind blowing, well, I think, yeah,
so I think that they're at my pliants. So we
in the US, all food is readily available everywhere. You
drive down the highway and there are signs everywhere, and.
Speaker 3: We eat French fries for a week more.
Speaker 2: Then we go to a restaurant and we're served a
three person portion and we continue to eat that way
and our bodies can't, uh can't keep up, and so
then there's this shifting of hormones that all of the
obesity problem does impact neuroentocrine system, central nervous system, cardiovascular system.
And so this impact is what we're trying to understand better.
Speaker 1: And then what actually stimulated us researching this and do
in this episode was recent information that was just released
on cancer rates. Yeah, so anything above ten percent is impressive,
and the recent data looks at reduction in cancer all
sorts of cancer, prostate, ovarian, breast cancer of twenty to
thirty percent.
Speaker 2: So again, the latest information on this particular evidence is
that we don't really know. An Umbrella review found no
substantial association between GLP one ra's use and cancer risk
across thyroid, pancreatic, and overall cancer outcomes. So we don't know,
and I think it's important for people to really understand
that in that certainly port eating can cause all kinds
of GI cancers and this and that.
Speaker 1: So one of the reason he mentioned thiraid is one
of the contraindications in the next section. We're going to
take a break and come back with side of But
one of the contraindications of this drug was a genetic
tendency towards thyroid cancer, and so they were specifically looking
at does this drug really cause an increase in thyroid
cancer with people with this genetic trait, And it turns
out that a huge meta analysis of ninety different studies
that there's no correlation. So that's not specifically talking to
the reduction in breast cancer. That's just talking about one
of the potential side effects. So we're going to take
a break here and then we're going to talk about
the side effects when we come back. Sound good, Okay,
we'll be right back. Hang with us again. Mind blowing
crazy therapy, Alice in Wonderland, magic medicine kind of stuff.
We'll be right back. Okay, we're back. I hope you
stayed with us. So now we're kind of in the
side effect the benefits of all of these things are
expanding and in ways that are again mind blowing for me.
But so the two big really scary things three probably
that were associated with these therapies was the genetic risk
of thyroid cancer, and you just mentioned that, studies now
show that's probably not as significant as what it was
initially thought.
Speaker 3: That is.
Speaker 1: The other big issue was retinal blindness associated with our
arteritis so vessels in the retina, and huge large meta
analysis multiple studies show that the risk of blindness with
these drugs is also pretty negligible.
Speaker 2: So I think it's important also to point out that
that very same meta analysis that was done showed there
was no significant increase for hypoglycemia. So people get all
caught up because they're on all these things, and so
they're concerned about their blood sugar dropping. And certainly if
you can.
Speaker 3: Cause you to feint to pass out, have car accidents.
Speaker 2: If you are on insulin or diabetic agents, certainly at warrants,
as you lose weight, that your requirement for insulin will
go down, or your requirement for those medications may go down.
So it's really important to keep monitoring and discuss that
with your provider if.
Speaker 1: You're disabetic doing these drugs, you absolutely need very frequent monitoring.
Speaker 3: By your provider. Also, that's exactly what these drugs affect.
Speaker 2: That meta analysis also did not show an increase in
the risk of retinopay or pancreatic events, and so that
really was reassuring to the population that those were not
going to be issues unless you had a previous history
of some pancreatic you know, right.
Speaker 1: So, pancreatitis is the pancreas produces digestive enzymes that get
released in the small intestine and they help break down
proteins and carbohydrates and absorb various nutrients. So when you
have like a really really bad faty meal, or if
you're predisposed and you have leaking of these gastric pancreatic enzymes,
you get a parrotinitis and really severe pain, and it
can be life threatening. So that was one of the
potential side effects, and I will say that that is
still probably the group of side effects that are most prominent.
Speaker 2: Well, the most prominent are nausea, vomiting, and diarrhea.
Speaker 1: Which I'm very very sensitive to these drugs. I've been
I tried to go on various different ones over the
course of a couple of years, and I'm trying them
again for my migraines, but I am extremely sensitive to
the nausea aspect. My daughter, genetically related to me, actually
tried these drugs. She was probably one hundred and fifty
pounds overweight, ended up in the hospital with chronic vomiting
for three days that she couldn't control. And those side
effects are the most common and they can definitely be
diminished by dose.
Speaker 2: Regulation, so you can mitigate most of the nausea, vomiting,
and diarrhea. BA gradual dose titration is very effectively kind
of you know, microdose at the front end and work
your way up, which is what is recommended and certainly
within the labeling of these drugs. And then as we
move forward, some of the emerging concerns, which we will
dive into a bit is potential loss of muscle and
bone mass with weight loss.
Speaker 1: Yeah, so this is the ozimpic face, is what it's
been called on Doctor TikTok, where you lose fat and
some muscle, but mainly the fat in the muscle, and
then you start looking kind of skeletal, and a lot
of celebrities we're just talking to our other daughter on
this is Father's Day when we're recording this, and we're
showing pictures of celebrities that look pretty skeletal.
Speaker 3: Yeah, and that's definitely one of the side effects.
Speaker 1: So how does that happen, Like, what's the mechanism of
that skeletal appearance.
Speaker 2: Well, so there's some concern of true muscle loss. But
then also, and.
Speaker 1: We talked previously that muscle mass is a huge metabolic
organ and if you're losing muscle mass, all sorts of
bad things can happen.
Speaker 3: So we like muscle.
Speaker 2: So there's muscle tissue, skeletal muscle tissue, but then there's
also the fat. As we get fatter, deposits into muscle
tissue and so then the muscle gets more lean. Additionally,
then you've got the loss of subcutaneous tissue and so fat.
Speaker 1: Yeah, most of your dormis or that if you can
pinch your skin, most of what you're pinching is actually fat.
Speaker 2: And there are ongoing studies looking at that particular issue.
So I think we just need to make sure that
we know that you know, when we're losing weight, we
want to achieve healthy weight loss. We want to make
sure we keep our protein intake high while we're losing weight.
Speaker 1: So then one of our friends the other night brought
up could you take other peptides like a growth hormone
analog to then stimulate muscle development, And we talked about
all of these peptides having benefits and side effects, and
the problem with growth hormone therapy is that it can
cause diabetes. So you know, you want to be careful
what you're mixing and matching here that if you're having
a side effect of muscle loss, you know, don't necessarily
rely on another treatment quick and easy fix, because that
can have side effects too. So interesting, before we get
into weird things, any other kind of documented side effects
that you'd like to talk about?
Speaker 2: Those are the big ones. I did have a question
for you, Keith in that in the bitinery medicine world,
what is the space looking like for animal health and
are we using GLP one ris for animals and are
they documenting the same side effects that we're having and
clearly some are not documentable.
Speaker 1: But yeah, so let me answer that in a second
after I talk about the other kind of weird human
side effects.
Speaker 3: The other weird thing that's.
Speaker 1: Happening with these drugs and side effects that we really
don't quite know and understand relates to the gastric motility.
So all of these drugs, you know, affect gastric motility, appetite,
eating calories in bulk fiber. Just you're eating less, you're
pooping less, your gi system slows down, and what that
seems to be doing is decreasing the absorption of some drugs.
Speaker 2: Yeah, so he's speaking to gastroparesis, which is one of
the potential side effects flowing down of the gut. And
certainly when the gut slows down and you take other
medications and then the transit time for those medications in
the gut is decreased and so absorption is higher.
Speaker 3: Usually lowers the concern.
Speaker 1: So the problem with this, and it could be higher too,
But the problem is that if you're on certain drugs
that are really really important, like statins for your cholesterol,
and suddenly your drug dose goes down or up, that's
a problem. Birth control. If you're taking birth control and
it becomes less effective, less absorbed, and you get pregnant,
that's a pretty big side effect.
Speaker 2: So the point that I was making with the higher
absorption drug is that the pharmacode dynamics have now changed
and we don't.
Speaker 3: Know yet, so you have to be careful though. Yeah.
Speaker 2: Yeah, so I think more information needs to come forth about,
you know, dosing with other medications on board. However, if
antibotics for NOMEN in their studies, you know, the drug
drug interactions are not super impressive.
Speaker 3: So yeah, but it's a concern.
Speaker 1: I mean, certainly if one of the side effects is
getting pregnant, that you know, we need to kind of
know about that. The other thing that we really don't
know is what's going to happen in thirty years when
you stop these drugs the weight gain returns?
Speaker 3: Is that correct?
Speaker 2: It does? And so the point being that if certainly
for the indicated use, what we don't know and what
we hope to have more information on is maintenance dose.
Is there a maintenance dose or do we stop?
Speaker 3: Yeah, could you use this?
Speaker 2: So we just don't know that we don't have or
take it.
Speaker 3: We don't have once a year, or we.
Speaker 2: Don't have you know, twenty year studies to look at
outcomes that far out. And so these are question unanswered
questions on the human side.
Speaker 1: Yeah, So going back to veterinary medicine. We're talking with
some friends about this last night, and there are a
lot of medications that on the veterinary side we can
use them because they have a lot of side effects.
But the dogs only live fifteen years, where humans live
potentially ninety years, and so if you're on a drug
for thirty years, that's a lot different than being on
a medication for three years. So there is a there
is an absolute difference in a lot of medications in
the veterinary world that we can use and avoid the
side effects simply because the lifespan is much short. And
that's sad, but that's just the reality. The other question
that you had asked before is are we using these
drugs in veterinary medicine, And the answer is that we're
beginning to. They're very expensive, and so a cost price
threshold is a little bit of.
Speaker 2: A So are there any studies among dogs or cats?
Speaker 1: Is actually where most of the interesting information is. So
most indoor cats are obese as they get older. And
what's also interesting is that they have a lot of
very annoying OCD food seeking behavior tendencies that drive you
own are crazy. So my daughter's cat when we go
visit non stop, is begging, meowing, buying at your ankles,
wanting food and very healthy weight cat but just once food,
NonStop and if you give it food, then it vomits
because it ate too much food. So these drugs, actually
they're not big studies. So we have like six animals here,
ten animals here, very very small compared to the human side,
but they are showing benefit in obesity and diabetes is
not that common in dogs, much more common in cats,
and so definitely this is something that's being explored across species,
and you know, it seems to have a lot of benefit.
But again mind blowing crazy, you know, unpredictable. Human medicine
had no glimpse of where this drug was headed in the.
Speaker 2: Potential, so in animal size, it looks like exanatide is
the drug that's being used.
Speaker 3: I was just looking at me.
Speaker 1: We use a lot of compounded drugs, so the Supreme
Court said that you can't patent these or trademark copyright
these drugs, and so there are a lot of compounded
drugs available. If we're using brand names, it gets really expensive.
Speaker 2: It appears in cats there was a forty percent diabetic
remission versus twenty percent in control, so kind of again about.
Speaker 1: Ten percent how many cats though, so it was it
was a small stuff.
Speaker 3: Yeah, and that's the problem.
Speaker 2: So the confidence intervals are really wide and so trusting
that data is.
Speaker 3: Based on the human data. I mean, it definitely looks
like it has a lot of potential.
Speaker 2: Sport to five cats by the way, five cats, Yeah,
that's not really a well that's medic caase study case report.
Speaker 1: Okay, So that's our update on the GLP ones. Please
send us any questions or comments to ask at itch
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Speaker 3: Stay well, stay safe, get up and move Okay, Bye
bye guys,